Get help to stop smoking!

This initial contact form can be completed by the person requiring support from the Health and Wellbeing Team to stop smoking, or by a professional working alongside the person. Please ensure that all sections of the form have been completed. Once the form has been received, we will contact you to arrange an initial discussion to agree with you the next steps.

Please e-mail the completed form to: [email protected]

Find the self-referral form here

Date published: 24th March, 2025
Date last updated: 9th March, 2026