Employee Application for Nicotine Replacement Therapy Form

Name/Title

Employee Application for Nicotine Replacement Therapy Form (PDF)

Document ID

TS4KSNFPVEZQ-89-1447

Current from

03/09/2015

Coverage

WACHS

Policy Type

Form

Summary

This form is completed by employees who wish to take up the offer of 8 weeks free Nicotine Replacement Therapy.

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