Hello

This your annual Asthma check up. You will not need to attend the Surgery.

This is the first step of the process. You will have to record certain information about your Asthma Symptoms.

After this we will review your records and call or text you with any changes to your medication in the next few weeks.

Things you need to know:

  • Exercise will always improve your breathing.
  • Smoking makes asthma worse.
  • Smoking causes asthma in children.
  • If you are breathless you must seek medical advice.

Asthma Review
Enter Email
Please use format day/month/year e.g. 12/05/1979

Your Asthma Review

In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
During the past 4 weeks, how often have you had shortness of breath?
During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
During the past 4 weeks, how often have you used your rescue inhaler or nebuliser medication (such as Albuterol)?
How would you rate your asthma control during the past 4 weeks?
How many days a week do use your reliever (blue) inhaler *
Have you been admitted to hospital in the last 12 months? *
Do you think you need to change your medication? *
Do you smoke? *
Are you an ex smoker?
Please use format day/month/year e.g. 12/05/1979

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.