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 Respiratory Nurse.

Please see our asthma fact sheet.

If you are symptom free and using your medication as prescribed, once you have submitted your asthma questionnaire we will email you to confirm that you medication has been updated & confirm your annual review date for the following year.

However, please note that you will not receive a personalised management plan or education session with one of our Specialist Respiratory Nurses, although you can arrange an appointment at any time in the future.

Asthma Review

Asthma Review

About You

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

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 (e.g., school, work, housework)? *