Asthma Review

DIGITAL SURGERY

Before you complete the form, please watch the Asthma Inhaler Technique videos.












    Before you complete the form, please download our Asthma Action Plan and watch the Asthma Inhaler Technique videos.


    About You











    Asthma Control Score







    Off target

    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

    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

    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.


    Additional questions

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