Smoking Status Question Title * 1. Patient Information First Name Last Name DOB Question Title * 2. What is your smoking Status Never Smoked Ex Smoker Current Smoker Question Title * 3. If you answered yes, how many do you smoke a week <1 cigarette or equivalent/day 1-9 cigarettes or equivalent per day 10-19 cigarettes or equivalent per day 20-30 cigarettes or equivalent per day 40+ cigarettes or equivalent per day Question Title * 4. The NHS can help you quit. Quit Smoking Clinics have a high success rate. www.SmokefreeHampshire.com Submit