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

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

If you are a smoker, we would recommend stopping. For help please call Healthy Lifestyles on 0800 122 3788 or email: glicb.hlsglos@nhs.net for support in stopping. Please visit HLS Gloucestershire for more information.

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