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NHS Smoking Helpline: 0800 022 4 332
Mon to Fri 9am to 8pm, Sat and Sun 11am to 5pm.
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GOSMOKEFREE
We just need to ask a few questions first...
Please select your gender
Male
Female
(required)
Please enter your first name
(required)
Please enter your surname
Are you contacting us for yourself or on behalf of someone else?
Self - Non Smoker
Self - Smoker
Behalf of someone - non-smoker
Behalf of someone - smoker
(required)
On average, how many cigarettes do you smoke per day?
1-5
6-10
11-15
16-20
21-30
31-40
41+
(required)
Please select your age band
Under 16
16-24
25-45
45+
Please enter your postcode
Are you pregnant?
Yes
No
Where did you hear about this service?
TV ad
Cigarette Pack
Internet
Leaflet
Newspaper advertising
Posters
Word of mouth
Telephone Directory
Other
Don't Know
Have you used this service before?
Yes
No
Have you used this service before?
Yes
No
Welcome back. Did you find the advice that we gave you last time helpful?
Yes
No
Did we give you details of a service in your local area last time such as your NHS Stop Smoking Service, GP, pharmacy or support group?
Yes
No
Did you access support from any of these services?
Yes
No
Since we last chatted, have you stopped smoking, cut down on cigarettes or are you still smoking the same amount?
Stopped Smoking
Cut Down
Same Amount
Before we chat, on a scale of 1 to 5 where 1 is low and 5 is high, how confident are you about stopping smoking?
1
2
3
4
5
On the same scale, how motivated are you to stop smoking?
1
2
3
4
5
Are you currently employed?
Yes
No
Student
Retired
Please enter your occupation
Please enter your email address
Would you be happy for us to contact you in the future via email?
Yes
No
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