Stop Smoking in the Workplace – Company Registration

Name:

Position:

Tel:

Ext:

Email:

Company Name:

Address:

Approximately how many smokers are there in your employ?
(if you have this information)
* If 6 or more smokers book appointments higher discounts may apply and / or our outreach service will operate from your premises if required

Would you like a consultant to attend your workplace to conduct smoking cessation sessions? (see above)