Smokefree Island
You can use the below form to request support to stop smoking in a number of ways. Whether you require online stop-smoking support, or you would prefer to stop smoking with the help of a telephone specialist, we’re here to help.
I would like to Book a face-to-face appointmentBook a telephone appointmentContact you about something else
First Name*
Last Name*
Address Line 1*
Address Line 2
Postcode*
Town
Country
GP Practice Name*
Email
Contact Number*
Date of Birth*
Gender
MaleFemaleOther
Preferred Time to Contact
MorningAfternoonEvening
May we leave a message?
YesNo
Smokefree Island 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.solutions4health.co.uk/contact-us).