Smoking

*Name: *Date of Birth (dd/mm/yy):

*Are You a Current Smoker?: Yes I do not smoke anymore I have never smoked

If you are a smoker and would like to give up then why not
call your surgery to find ways of giving up?

If you have given up smoking, please supply us with the approximate date that you stopped (dd/mm/yy):

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(Characters are not case sensitive):

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