Smoking Status

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

Smoking Status

Smoking Status

Smoking Review

Do you currently smoke?

Do not currently smoke section

Have you smoked in the past?
How many cigarettes did you smoke in a day?

Do currently smoke section

Do you use an electronic cigarette / vaping?
Would you like to give up smoking?
*

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