Cookies on this website

This website would like to use analytics cookies. These send information about how our site is used to a service called Google Analytics. We use this information to improve our site.

Let us know if this is OK. We'll also use a cookie to save your choice. You can read more about how Google uses cookies.

Wycliffe Surgery NHS Devon ICB

Opening Times

Search this website

Home
Appointments
Prescriptions
Clinics, Services & Reviews
Register with our Practice
Practice Team
Contact

Home
Smoking Review

Smoking Review

If you have been advised by the surgery to submit a smoking review, please use the form below.

Step 1 of 4

25%

Name

First Last

Phone Optional

Date of Birth

Day

Month

Year

Email Optional

Do you currently smoke?

Yes

If yes, how many do you smoke in a day?

1 to 9 Optional

10 to 19 Optional

20 to 39 Optional

40 or more Optional

If no, have you smoked in the past?

Yes Optional

No Optional

If you are a smoker and you would like information or help with stopping smoking:

Consider calling the surgery to book an appointment with one of our Smoking Cessation Nurses Optional

Consider visiting the NHS smoke free website Optional

Keep these options in mind for future if you are not quite ready to quit. Optional

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

60451

Additional Information

Carers Advice

Data Protection - GDPR

Military Veterans

Non-NHS Services

Patient Participation Group

Veterans & Family Hub

Support links

Accessibility statement
Contact us
Cookies
Privacy policy
Data Processing
Admin Login