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About Us
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Jenner Healthcare Leaflets
Have your Say
Making the most of your Practice
Meet the Team
Practice Management and Administration
Doctors
Nursing Team
Pharmacy and Dispensary
Allied Health Professionals
Social Prescriber
Opening Hours
What to do when we are closed
Practice Policies
At the Practice
Data
Patient Record
The National Care Record Service (NCRS)
Patient Rights
Website Policies
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Know Who to Turn to for Your Healthcare
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Health Topics
Anxiety, worry, fear and panic
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder (ASD)
Dr Sophie’s Videos
Get the right help
Lipids (Cholesterol and triglycerides)
Low mood, depression and suicidal thoughts
Menopause and Hormone Replacement Therapy (HRT)
Non-alcoholic fatty liver disease (NAFLD)
Sleep problems
Stress
Weight Management
Online Services
Register for Online Services
NHS App
Practice Services
Travel Clinic & Holiday Vaccinations
Forms
Keep us up to Date
Health Review Forms
Help & Support
News
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Smoking Review
First Name
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Last Name
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Date of birth
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Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Your Smoking Status
Do you currently smoke?
*
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How many cigarettes do you smoke each day?
1 to 9
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20 to 39
40 or more
Would you like to give up smoking?
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How many cigarettes did you smoke each day when you were a smoker?
1 to 9
10 to 19
20 to 39
40 or more
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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
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to discover how we protect and manage your submitted data.
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Home
About Us
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Jenner Healthcare Leaflets
Have your Say
Making the most of your Practice
Meet the Team
Practice Management and Administration
Doctors
Nursing Team
Pharmacy and Dispensary
Allied Health Professionals
Social Prescriber
Opening Hours
What to do when we are closed
Practice Policies
At the Practice
Data
Patient Record
The National Care Record Service (NCRS)
Patient Rights
Website Policies
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Know Who to Turn to for Your Healthcare
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Clinics
Health Topics
Anxiety, worry, fear and panic
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder (ASD)
Dr Sophie’s Videos
Get the right help
Lipids (Cholesterol and triglycerides)
Low mood, depression and suicidal thoughts
Menopause and Hormone Replacement Therapy (HRT)
Non-alcoholic fatty liver disease (NAFLD)
Sleep problems
Stress
Weight Management
Online Services
Register for Online Services
NHS App
Practice Services
Travel Clinic & Holiday Vaccinations
Forms
Keep us up to Date
Health Review Forms
Help & Support
News