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Wanting to quit smoking?

Our Nurses can prescribe Nicotine replacement therapy to help support your journey.

Complete the form and our Nurses will write a prescription for you to take to the pharmacy (prescription fees apply at some pharmacies)

Prescription request form

After waking up i........
How many cigarettes do you smoke a day?
Which product would you prefer?

Good luck

Please call 0226528957 if you have any problems completing this form