Don't worry… You're up to four times more likely to stop smoking successfully with the support of Smokefree Norfolk

What happens when I contact Smokefree Norfolk?

Complete the form below in as much detail as possible or if you’d prefer to talk to us, call our freephone number 0800 0854 113.

We have specialist Stop Smoking Advisors based all around Norfolk, and we'll match you with an advisor close to you based on the address that you provide.

Your advisor will get in touch (by phone, text or email - whichever you prefer) within the next few days to set up an appointment. At the appointment, he or she will talk you through all the options available to find what suits you, and will support you to help you quit.

Your details

Name*

Address

Email*

Phone Number

Mobile Number

How would you like us to contact you?

 Phone Call  Text  Email

If phone call, can we leave you a voicemail?

 Yes  No

Best time for us to contact you

 Morning  Afternoon  Evening

You and Your Health

Date of Birth

NHS Number (if available)

GP Name

GP Practice Address

Have you tried to quit before?

 Yes  No

How many times?

Number of cigarettes/amount of tobacco used per day

Any health problems related to your smoking (e.g. cough, chest infection)

Any other details

Security

Type the characters you see in the picture below.

We will never share your details with any third party, and the information you provide will be treated in the strictest confidence.

* Denotes a required field.

Call Us On: 0800 022 4332 or fill out our simple Contact Form

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