Asthma Review

If you have been advised by the surgery to submit an annual review of your asthma symptoms please use this form. If your symptoms are deteriorating or you are having any concerns please make an appointment with our Nurse.

Asthma Review

Asthma Review

About You

Please use this date format: DD/MM/YYYY.

We will only use this email address for correspondence in relation to this request and will not sell it onto third parties.

Your Asthma Review

In the last month have you had difficulty sleeping due to your asthma (including cough)?
Have you had your usual asthma symptoms (e.g., cough, wheeze, chest tightness, shortness of breath) during the day?
Has your asthma interfered with your usual daily activities or exercise (e.g., school, work, housework)?
How often do you need to use your reliever inhaler?
Since your last review, have you needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of your asthma?
Since your last review, have you needed a course of steroid tablets to get your asthma under control?
Do you smoke?
Did you have a flu vaccination last flu season?
Would you like to decline the flu vaccination at the practice next season?

Please note that the details you give will be used to update your medical records.