Smoking Review

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

Bungay Medical Practice Smoking Review

Section

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?
*

If you would like help quitting please contact One Life Suffolk on 01473 718193 or visit their website at https://onelifesuffolk.co.uk/services/stop-smoking/