Thank you for taking the time to tell us about your Smoking Status (whether you are a smoker, ex-smoker or have never smoked).
Date of Birth
Please complete this form and hand it in to reception.
The information you supply us will be used lawfully, in accordance with the Data Protection Act 1998. The Data Protection Act 1998 gives you the right to know what information is held about you, and sets out rules to make sure that this information is handled properly.