Health Van Smoke Free Feedback Step 1 of 2 50% What practice are you registered with?Askern Medical PracticeASA Medical GroupBarnburgh SurgeryConisbrough Group PracticeConisbrough Medical PracticeDenaby Medical PracticeDon Valley HealthcareDunsville Medical CentreField Road SurgeryHatfield Health CentreMexborough Health CentreNorthfield SurgeryPark View SurgeryPetersgate Medical CentreScawsby Health CentreSt John's Group PracticeSt Vincent Medical CentreThe Burns PracticeThe Edlington PracticeThe Flying Scotsman Health CentreThe Great North Medical GroupThe Kingthorne Group PracticeThe Lakeside PracticeThe Mayflower Medical PracticeThe Medical CentreThe Mount Group PracticeThe Nayar PracticeThe New SurgeryThe Oakwood SurgeryThe Ransome PracticeThe Regent Square Group PracticeThe Rossington PracticeThe Scott PracticeThorne Moor Medical PracticeTickhill and Colliery Medical PracticeWest End ClinicWhite House Farm Medical CentreAge 24-34 35-44 45-54 55-64 65 or Above Prefer Not to Answer Ethnicity Asian or Asian British Black, Black British, Caribbean or African Mixed or multiple ethnic groups Gypsy, Traveller or Roma Community White Other ethnic group Prefer Not to Answer Which location did you visit? Clock Corner Vermuyden Centre Market Street Morrisons Armthorpe ASDA Carcroft TESCO Balby Lakeside Shopping Outlet Askern Lakeside Original Factory Shop Mexborough Have you recieved a FREE carbon monoxide test during your visit? Yes Optional No Optional Do you smoke? Yes No If yes, how many cigarettes do you smoke a day? 1-5 Optional 6-10 Optional 11-15 Optional 16+ Optional If no, do you live with someone who smokes? Yes Optional No Optional Have you tried to quit smoking before? Yes Optional No Optional If yes, why did you start to smoke again? Optional How did you hear about our service? Social Media – Facebook, Twitter, Instagram Optional Primary Care Doncaster Website Optional My GP Practice Optional Doncaster Council Optional Other Optional Optional Has your knowledge around smoking and respiratory illnesses improved from your conversation today? Yes Optional No Optional Any further comments? / What did you learn from today? Optional
