Support to stop smoking

If you or someone you know would like support to stop smoking, complete this form and we will be in contact.

Oranga Hā - Tai Poutini: Stop Smoking West Coast provides free smokefree support to anyone who wants to stop smoking and lives on the West Coast.

Are you pregnant?
Which ethnic group do you belong to? You can select more than one.
Do you have an iwi affiliation?
If yes, select your iwi.
Is this referral for yourself?