Tell us whether you accept cookies

We've put some small files called cookies on your device to make our site work. We would also like to use analytical cookies to understand how our site is used and improve user experience. Analytical cookies send information to Google Analytics.

Let us know your preference. We will use a cookie to save your choice. Before you make your choice you can read more about our cookie policy.

Cotswold Medical Practice NHS GP Surgeries in Bourton-On-The-Water & Northleach

Smoking review

Smoking Review

Smoking status: *

Smoker

Never smoked

Ex-smoker

Smoker

What do you mainly smoke?

Cigarettes

Cigars

Rollups

Pipe

E Cigarettes

How many cigarettes do you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

How many cigars do you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

Rollups – How many grams of tobacco do you smoke per week? *

Pipe – How many grams of tobacco do you smoke per week? *

Would you like to give up smoking? *

Yes

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

Ex Smoker

What did you mainly smoke?

Cigarettes

Cigars

Rollups

Pipe

E Cigarettes

How many cigarettes did you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

How many cigars did you smoke in a day? *

1 to 9

10 to 19

20 to 39

40 or more

Rollups – How many grams of tobacco did you smoke per week? *

Pipe – How many grams of tobacco did you smoke per week? *

When did you give up smoking? *

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

If you are human, leave this field blank.

Moore Health Centre
Moore Road
Bourton On The Water
Cheltenham
GL54 2AZ

Get directions

01451 820 242

Westwoods Surgery
Bassett Road
Northleach
Cheltenham
GL54 3QJ

Get directions

01451 860 247

Feedback and complaints

Wellbeing

Accessibility statement

Website policies