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Make a referral to Stop Smoking Support Havering, Barking and Dagenham

Service access criteria

Tick to confirm you have checked the service access criteria "Havering Residents / Barking and Dagenham Residents / People that work for Barking and Dagenham council / age 12+ Registered with GP in Barking and Dagenham / Registered with GP in Havering"

Your Details

Who are you referring?

Don't know / client doesn't have an email address

Additional referral details

Other:
Other:

Confirmation and consent

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