Smoking Review

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

If you smoke, we strongly advise that you stop. If you would like help with this, please visit the Stop Smoking London website.

Smoking Review

Smoking Review

About You

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Smoking Review

Do not currently smoke section

Do currently smoke section

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

Sending