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 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

If you are interested in stopping smoking, you can self-refer to Smoke Free Life Berkshire, or telephone 0800 622 6360.

Clinics are held in the following locations 3 days a week:

Monday - Strawberry Hill Medical Centre
Tuesday - Tesco on Pinchington Lane
Saturday - Newbury Market

How many cigarettes do you smoke in a day?
*
*
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