Make an Appointment
Request an Appointment Online
First
Last
An exacerbation is where your breathlessness or cough got worse and you needed to take a rescue pack or to seek medical attention.
Please note 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’.
If you used to smoke something other than traditional cigarettes (e.g roll-your own or cigars) but you aren’t sure what the equivalent in cigarettes is then please select your best guess.
Other forms available
Accessibility Tools