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Professional referral

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Quit smoking
Pregnancy
Professional referral

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Resources
Contact us

News and Events
Resources
Contact us

Self refer today for support to quit for good

Self refer

Self refer today for support to quit for good

You can use the below form to request support to stop smoking in a number of ways.

We’re here to help

Online stop-smoking support.
Stop smoking with the help of a telephone specialist.
12 week stop smoking programme.

Do you want to; *

I would like to

Book a face-to-face appointment Book a telephone appointment Contact you about something else

First Name

Last Name

Address Line 1

Address Line 2

Post Code

Town

Country

Date of Birth

GP Practice Name

Gender

Gender

Male Female Other

Email *

Contact Number *

Preferred Time of Contact

Preferred Time of Contact

Morning Afternoon Evening

May we leave a message?

May we leave a message?

Yes No

I consent to the below use of my data: *

I consent to the below use of my data

Yes No

Smokefree Enfield and Solutions4Health would encourage you to provide your consent in order that we can process data and information about you. We will share this data where necessary with other health professionals such as your GP or specialist services. The information we collect and process will be used to help us meet the contractual obligations as set down by the local health service commissioners in accordance with the service we are providing. You can request to view, amend or delete your data at any time by contacting us at (www.smokefreeenfield.co.uk/contact-us).

Confirmation

I confirm the above details are correct.

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Registered Office

Smokefree Enfield Unit 1 Thames Court Richfield Avenue Reading RG1 8EQ

Phone: 020 3633 5033

Email: smokefree.4enfield@nhs.net

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