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Mann Cottage NHS GP Surgery in Moreton-in-Marsh

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.

*

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

If you are human, leave this field blank.

Sending

Four Shires Medical Centre
Stow Road
Moreton-in-Marsh
Gloucestershire
GL56 0DS

Get directions

01608 650764

About the surgery

Register with the surgery

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