Get the free STOP SMOKING SERVICE - REFERRAL FORM - clchnhsuk

STOP SMOKING SERVICE REFERRAL FORM Please PRINT your patients details below. Patients Name Male/Female Pregnant Yes/No Please fax this form to: Address Daytime Telephone REFERRER INFORMATION 020 7563

How to fill out stop smoking service

How to fill out stop smoking service?

1. Begin by researching different stop smoking services in your area. Look for options that fit your specific needs, such as group sessions, individual counseling, or medication assistance.
2. Contact the chosen stop smoking service provider to inquire about their enrollment process. They will typically provide you with the necessary forms or guide you through an online registration process.
3. Fill out the required personal information on the enrollment form. This may include your name, address, contact details, and demographics.
4. Provide your smoking history on the form. This may include the number of cigarettes smoked per day, the duration of your smoking habit, and any previous attempts to quit.
5. Indicate your preferred method of quitting on the form. This could be through counseling, medication, support groups, or a combination of approaches.
6. If you have any pre-existing medical conditions or take medications, disclose this information on the form. It is important for the stop smoking service provider to be aware of any potential interactions or considerations.
7. Submit the completed enrollment form to the stop smoking service provider. They may require you to send it via mail, email, or drop it off in person.
8. Wait for confirmation from the provider regarding your acceptance into the program. This may include further instructions, an appointment for a consultation, or details about the next steps in the process.

Who needs stop smoking service?

1. Individuals who are determined to quit smoking but have been unsuccessful on their own.
2. People who want professional assistance and guidance during their journey to quit smoking.
3. Individuals who have tried various methods to stop smoking without long-term success.
4. Smokers who have experienced health issues related to smoking, such as respiratory problems or heart disease.
5. People who want access to resources and support systems specifically designed to help smokers quit successfully.
6. Individuals who are looking for a comprehensive approach that addresses both the physical and psychological aspects of nicotine addiction.
7. Smokers who prefer professional assistance in creating personalized quit plans and strategies.

Remember, stop smoking services can vary in availability and approach, so it's important to research and find the one that aligns with your specific needs and goals.

For pdfFiller’s FAQs

What is stop smoking service?

Stop smoking service is a program or initiative that provides support and resources to help individuals quit smoking.

Who is required to file stop smoking service?

Healthcare providers and organizations that offer smoking cessation services may be required to file stop smoking service.

How to fill out stop smoking service?

To fill out stop smoking service, providers must include information about the services offered, number of participants, outcomes, and any follow-up care provided.

What is the purpose of stop smoking service?

The purpose of stop smoking service is to help individuals quit smoking and improve their overall health.

What information must be reported on stop smoking service?

Providers must report information such as number of participants, type of services offered, success rates, and any follow-up care provided.

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