Stop smoking referrals
NHS referrals (for health professionals only)
Health professionals can refer smoker patients by completing the secure referral form.
Self-referral form (this form is for smokers to refer themselves)
By completing this stop smoking referral form, you automatically consent to sharing your information. Our Public Health privacy notice explains how your information is shared.
Please make sure to fill in all fields on the self-referral form or we will be unable to complete your request.