Smoking Status Update

Collects smoking status of a patient

Last Updated: 13/01/2020

Name and contact details

Smoking Status

Collecting current patient status


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.