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Key Information

Call 111 - When it is less urgent than 999
CQC Report: good, caring, safe

Smoking Questionnaire

Please take a couple of minutes to fill in our smoking questionnaire whether you smoke or not. This will enable us to quickly and easily update your patient records with your smoking status.

Smoking Questionnaire

Please enter amount in the appropriate box:

Cigarettes / Cigars per day OR
grams of tobacco per week

Are you aware of the CAMQUIT Smoking Clinic on 01480 418693 and that you can also see one of the Practice Nurses or doctors to help you quit smoking.


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Your Neighbourhood Professionals. Just a Click Away! M Collins -Butchers
Your Neighbourhood Professionals. Just a Click Away! M Collins -Butchers