Smoking Review

Many of our usual procedures have been amended in response to the current Coronavirus pandemic. Please check our Coronavirus Updates page for the most up to date guidance.

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

Please do not use this service for any urgent medical queries as this service is only monitored during practice working hours on a daily basis.

Please note: If you have an urgent medical query you should telephone the surgery or contact the out of hours service by calling 111.

Smoking Review

Smoking Review

About You

Please use this date format: DD/MM/YYYY.

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?

Click here for free advice and support in Buckinghamshire

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