Asthma Review

 

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Personal Details
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Asthma Control Score
Your Score

Off Target

You scored 

Your asthma may not have been controlled during the past 4 weeks.
Your Doctor or Nurse may recommend an asthma action plan to help improve your asthma control once you have submitted this form.

On Target

You scored 

Your asthma appears to have been reasonably well controlled during the past 4 weeks.
However, if you are experiencing symptoms your Doctor or Nurse may be able to help you, please let a Doctor or Nurse know.

Well Done

You scored 

Your asthma appears to have been under control over the last 4 weeks.
However, if you are experiencing symptoms your Doctor or Nurse may be able to help you, please add these into the comments box at the end of this form.

 
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Additional Questions

Additional Questions

Please complete the additional questions below and then press submit to send your review to your Doctor.

How to get an asthma action plan

If you’re not using an asthma action plan yet, it’s easy to get started:

  1. Download an asthma action plan here. If you can, print out a copy to take to your GP or asthma nurse.
  2. Book an asthma appointment with your GP or asthma nurse.
  3. At the appointment, talk through the plan with your GP or asthma nurse and fill it in together. You can do this by telephone or video call too if your appointment isn’t in the surgery. Ask them to save a copy onto your notes and send it to you on email, SMS or WhatsApp.

Inhaler technique demonstration videos can be found by clicking here

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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