Show Side Menu
Call 111 - When it is less urgent than 999
Contact Us

Annual Asthma Review Questionnaire

Are you in control of your asthma? Or is your asthma in control of you? 

As part of your annual asthma review, we would like to invite you to complete this asthma management questionnaire to provide the GP with some basic information of your asthma control.  This will highlight anything that the GP needs to address as part of your review and also gives you the opportunity to tell us about any issue that you feel you have with your asthma or would like some extra support with. If you have any problems completing the questionnaire, please speak to a receptionist who will be happy to go through it with you. 

Please read through the questions carefully and answer as honestly as you can.

Annual Asthma Review Questionnaire
If no, please detail what support you feel that you need.
This can be number of cigarettes, number of e-cigarette usage etc.
If yes, please also write if you would like us to contact you regarding this.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Local Services. Ready to Help You