Smoking Review

Section

Do you currently smoke?

Yes

No

Do not currently smoke section

Have you smoked in the past?

Yes

No

How many cigarettes did you smoke in a day?

1 to 9

10 to 19

20 to 39

40 or more

Do currently smoke section

How many cigarettes do you smoke in a day?

1 to 9

10 to 19

20 to 39

40 or more

There are many health benefits to giving up smoking and we recommend that everyone stops smoking. This can be difficult sometimes and there are many ways you can access help with this. Healthy lifestyles Gloucestershire can help if you call free on 0800 122 3788. We also have trained staff in the surgery who can help people give up smoking.

Would you like to give up smoking?

I do not feel that I am ready to give up smoking at the moment

I am ready to give up smoking and I will contact healthy lifestyles Gloucestershire

I am ready to give up smoking and I will contact the surgery to book an appointment to discuss this in a ‘support to stop smoking’clinic

*

I confirm that the information provided is accurate to the best of my knowledge

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

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Smoking Review

Smoking Review

Section

Smoking Review

Do not currently smoke section

Do currently smoke section

Self Help