Adult Asthma
Questionnaire

Make an Appointment

Request an Appointment Online

Health Co-Pilot

Adult Asthma Questionnaire

Required fields are marked with an asterisk (*).

An exacerbation is where your symptoms got worse, your reliever did not help and you needed to seek medical attention.

Enter an approximate number is fine here.

Please not that your answers will not be seen immediately and you should direct any urgent queries to your healthcare team

Please not that ‘smoking status’ refers to smoking tobacco products, and NOT the use of e-cigarettes or ‘vaping’. If you only use e-cigarettes or ‘vape’ then please select ‘Ex-smoker’ (if you used to smoke tobacco products or ‘Never smoked’.

Please not that your answers will not be seen immediately and you should direct any urgent queries to your healthcare team

Privacy Consent – 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 submitted data.

We're here for you

Mental Health Resources

Other forms available

error: Content is protected !!
Skip to content