Smoke Free S2S Feedback Smoke Free S2S Feedback Step 1 of 2 50% What practice are you registered with?Barnburgh SurgeryConisbrough Group PracticeeMexborough Health CentreThe Edlington PracticeThe Mayflower Medical PracticeThe New SurgeryThe Rossington PracticeTickhill and Colliery Medical PracticeWest End ClinicAge 19-23 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? Rossington Practice Conisbrough Group Practice 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 Have you tried to quit smoking before? Yes Optional No Optional If yes, why did you start to smoke again? OptionalHow 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
