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Leading Change Through Innovation

Chiltern House Medical Centre

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Smoking Review Form

Smoking Review
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Please use format day/month/year e.g. 12/05/1979

Your Smoking Status

Privacy Policy

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 Privacy Policy to discover how we protect and manage your submitted data.

Health A-Z

Guide to conditions, symptoms & treatments

Live Well

Advice, tips and tools for health & wellbeing

Medicines Guide

How medicine works & possible side effects

Care & Support

Options & where to get the best support