Monday, 6 February

Spring clean your business and go smoke-free!

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Contact & Booking Details

Contact & Booking Details

This is the online booking form for Enfield & Haringey Quit Smoking Service. Hopefully you have read through the information on the treatment options available to you and, in the case of the Specialist Smokers' Clinic, have noted the most convenient location and start date for you.

 

Before completing this form, please bear in mind that for all areas of the service, you MUST be available to attend every session at the clinic or with your Specialist Advisor.

 

If you think you will not be available for each session of the clinic treatment programme, for example due to planned holiday, please check the relevant clinic section for a later start date or contact our team on freephone 0800 652 8405 or via email at stopsmoking@innovisionhc.co.uk with your name, address, telephone number and preferred clinic location and you will be contacted as soon as a new clinic date is set.

 

Otherwise, please complete the following form, completing all sections as necessary.


Section 1
Title First Name Surname
Address 1
Address 2 Postcode
Home Phone Work Phone
Mobile Phone
Where did you hear about the service?


Section 2
GP Name
Address


Section 3
How many cigarettes do you smoke a day? 
How soon after you wake up do you smoke your first cigarette?


Section 4

What type of advisor would you prefer?


If you are a heavily dependant smoker (15-20 and above per day and you smoke the first cigarette of the day within 30 mins of waking) you should attend the clinic. If you are a lighter smoker, or are unable to attend a clinic then use a level 2 advisor.

 Specialist Clinic (go to section 5)
 Level 2 Advisor (skip section 5)


Section 5
If clinic, state preferred location 

Prebooking Details

  • YOU SHOULD CONTINUE TO SMOKE UNTIL QUIT DAY (THIRD SESSION)
  • Postal confirmation of booking will be sent, including a questionnaire which must be completed and brought on the first session.
  • Each session is 2 hours but first session sometimes takes slightly longer.
  • Only those booked on the clinic may attend (no extras).
 I have read the prebooking details