Stop-smoking support to Individuals & Groups self-assessment questionnaire
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1. Personal Details:

Introduction:

The purpose of this questionnaire is to support students to access the most appropriate training for their role & needs and the following questions will assist with determining this. It is for the benefit of the student to provide accurate answers as the Specialist Stop-smoking Support to Individuals and Groups module builds on your existing knowledge. The information within this questionnaire is confidential and contact details are required in case a member of the PATH training team needs to get into contact with you.

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1. Name:

Name:

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2. Health Board Area:

Health Board Area:

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3. Employer:

Employer:

*
4. Job Title:

Job Title:

*
5. Email address:

Email address:

*
6. Contact Number:

Contact Number:

Stop-smoking support to Individuals & Groups self-assessment questionnaire Exit this survey

1. Personal Details:

*1. Name:

*2. Health Board Area:

*3. Employer:

*4. Job Title:

*5. Email address: