Asthma Review Forms

Asthma Review Form

For patients who are due an annual asthma review.

Date of Birth

Asthma Review Questionnaire

In the last month has your asthma interfered with your usual activities (e.g. housework, work, school etc)?
Have you ever had your peak flow measured at the surgery?
6. Are you happy with your inhaler technique?
Have you ever smoked?
If 'yes' Do you smoke now?
If 'No' when did you quit? If 'No' when did you quit?
There are plenty of options available to help you quit. Is this something you would like us to contact you about?

Asthma Control Score