Smoking Status

Please fill out this form to let us know your current smoking status.

Smoking Review

Section

Smoking Review

Smoking status: *

Do currently smoke section

How many cigarettes do you smoke in a day? *
Would you like to give up smoking?

Please visit the following website for advice on how to quit smoking:

www.nhs.uk/better-health/quit-smoking

Used to smoke section

How many cigarettes did you smoke in a day?
Sending