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

About You

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

Smoking Review

Smoking Status

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?
The Surgery provides help and support to patients who would like to cease smoking.

At the practice we have qualified Health Care Practitioners who can see you in their clinics to discuss the available resources to sustain a successful quit attempt including the use of patches and nicotine replacement therapy medicines (some of which will require prescriptions). They can also organise a referral for you to the NHS Stop Smoking Service `Smokefree’ and offer follow up appointments for on-going support.
If you wish to make an appointment, please tick the box and we will contact you. Alternatively call the Surgery directly on 01525 715 300.

If you prefer, you can also refer yourself directly to the local NHS Stop Smoking Service `Smokefree Bedfordshire’. This is a service developed by experts and ex-smokers to provide tailored plans to help smokers quit. They also offer one to one support similar to that offered by the practice as well as online support using texts and apps. Further details are on their website at: https://www.nhs.uk/smokefree.

I wish to make an appointment to see a Health Care Practitioner
*
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