* 1. Please enter your Postcode.

* 2. Are you a ?

* 3. Are you a ?

* 4. Are you aware of NHS Lanarkshire's Stop Smoking Service?

* 5. Does anyone else in your household smoke?

* 6. Is your home smoke-free?

* 7. Is your car smoke-free?

* 8. Second-hand smoke is harmful to other peoples' health?

* 9. Children exposed to second-hand smoke have more asthma attacks, chest & ear infections and are more likely to be off school?

* 10. NHS Lanarkshire would like to thank you for your time. 
Please supply your name and mobile number, in the box below, which will be entered into the free draw to win a signed HAFC football. 
All information is anonymous and will not be used for any other purpose.