Make a professional referral

Please use the below form to make a patient referral to one of our Smokefree Hampshire stop smoking services.

Whilst many of these fields are optional, we do request you provide your referrer details, so that any clarifications can be made to aid in the correct triaging for the service user. 

If you are a member of the public looking to stop smoking and request either telephone or online support, please use the form on our self-referrals page.

DD/MM/YYYY

Registered Office
Smokefree Hampshire,
Grove House,
Lutyens Close,
Chineham Court,
Basingstoke,
RG24 8AG

Telephone
01264 563039 or 0800 772 3649

Email
smokefree.hampshire@nhs.net

Smokefree Hampshire is your local stop smoking service commissioned by Hampshire County Council.