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Abbey Road Surgery NHS GP Surgery in Hertfordshire

Smoking review

Smoking Review

Section

Smoking Review

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

Would you like to give up smoking?

Yes

No

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

Would like to be referred to the stop smoking clinic?

Yes

No

*

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

If you are human, leave this field blank.

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63 Abbey Road
Waltham Cross
Hertfordshire
EN8 7LJ

Get directions

01992 654004

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