BG - Asthma Review Form

This form is used for your Annual Asthma Review. Please answer the questions and submit this form to us.

Your completed questionnaire will be reviewed by me, Nikki Kierans, Specialist Respiratory Nurse, to ensure that the management of your condition is optimised.  The Surgery will contact you if I feel that you need a face-to-face review in the surgery based on your questionnaire. 

If you have any concerns regarding your Asthma at any time, please feel free to contact the surgery.

Last Updated: 10/04/2024

Your Details

General Health Information

Asthma Control Score

Hospital Admissions

A Hospital Admission is defined as an overnight stay on a ward.

Asthma Review


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