Stop Smoking Professional Referral

When referring to the stop smoking service you will achieve QOF SMOk004 & SMOk005

Find your NHS number here https://www.nhs.uk/nhs-services/online-services/find-nhs-number/

Stop Smoking – Professional Referral
Patient’s Name
Patient's Name
First
Last
Patient’s Gender
Does your patient require an interpreter?
Patient’s Address
Patient's Address
City
County
Postcode
Is your patient over the age of 12?
Patient must work, study or live in Warwickshire or must be registered with a Warwickshire GP
Name of Referrer
Name of Referrer
First
Last
Data Consent
Contact Consent