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Making an online referral is simple, safe and secure. All submissions are protected by encryption. Your information is confidential - we will only share it with professionals outside of Change Grow Live if we believe you or someone else is at risk of harm.

Your information will be stored for a limited period within the secure Formstack database. It will then be kept within Change Grow Live’s internal storage systems. Only the Change Grow Live staff members who require access to your information in order to arrange your care will have access.

If you are providing someone else’s personal information in this form, you must have consent from that individual to do so.

How much money could you save by stopping smoking?

Answer the two questions below and then click “Calculate” to see how much money you could save!


Your savings

Please note that the figures above are simply an indication of how much you could save based on the cost of a packet of cigarettes and your daily intake.