Hope Family Medical Centre

01978 760468

Asthma Form

Asthma Review Questionnaire

  • MM slash DD slash YYYY
  • If you do not feel you need an asthma review please ensure you complete the following form completely.
    This is an episode requiring a visit to your GP/OOH/HOspital.
  • If you are ready to stop smoking get help https://www.helpmequit.wales/
    Are you struggling to use your inhalers, getting recurrent thrush etc
  • Dry powder inhalers are better for the environment, you will be booked an appointment to check you can use it properly. Please see https://www.asthmaandlung.org.uk/conditions/asthma/changing-lower-carbon-inhaler
  • https://www.drinkaware.co.uk
  • https://bcuhb.nhs.wales/health-advice/help-with-my-weight/
  • https://www.asthma.com/understanding-asthma
  • MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

What happens next?
If you answered Yes to some of these questions you may require a text, telephone or face to face appointment. Our admin/clinical team will be in contact with you if this is the case.

If no appointment is required your medication can be reauthorised for appropriate duration.

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.

Date published: 8th October, 2020
Date last updated: 23rd April, 2024