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Soomaaliya

Lawrence Hill
Health Centre

Hassell Drive, Bristol, BS2 0AN

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Smoking Review

Smoking Review

About You

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

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.

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

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Services

Alcohol
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Blood Taking
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Drug Problems
Ear Syringing
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Get U Better App
Hay fever
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Joint Injections
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Sexual Health
Sick Notes/Fit Notes
Smoking Cessation
Teen Health
Test Results

Our Policies

Accessing your GP-held records
Chaperones
Disability Access
Freedom of information
GDPR
GP Earnings
Infection Control Statement
Named GP
Non-NHS Work
Patient Confidentiality
Private clinics
Referrals
Statement of Intent
Suggestions, Comments and Complaints
Summary Care Records
Translation Service
Your Rights and Responsibilities
Zero Tolerance

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