Do you smoke?

As our patient, we’re interested to know whether you smoke or not. Once we know this, we can offer you the right level of support.

Do you smoke?

1. Your details

Do you currently smoke?

2. Smoking

2a. What do you smoke? (tick all that apply)
2b. How many cigarettes do you smoke a day?
2c (i). Do you roll your own cigarettes or smoke a pipe?
Would you like support in quitting smoking?

3. Non-smoking

3a. Please tick the most relevant option:
3b. Does anyone in your household smoke around you? (Passive smoking)