Northam Surgery

Smoking Status

Title

First Name

Surname

Telephone Number

Your smoking status...

You are up to 4 times more likely to quit smoking successfully using your local NHS Stop Smoking Service. Support is free and Nicotine Replacement Therapy is available on prescription. Simply call 01884 836024 to speak to a local advisor. Or email us at d-pc.stopsmoking@nhs.net

By using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your details.Personal information retained on this system is stored in a secure data centre located in the UK and is treated as confidential.