Smoking Review

If you have been advised by the surgery to submit a smoking review on a regular basis please use this form.

Smoking Review

Smoking Review

Section

Smoking status: *

Smoker

What do you mainly smoke (select all that apply)?
Please select one of the following:
Would you like to give up smoking?

Please ask at reception for more information about giving up smoking.

Ex-smoker

What did you mainly smoke (select all that apply)?
Please select one of the following:
*
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