Asthma Review

Please ONLY complete this form if advised by the Practice.

If your symptoms are deteriorating or you are having any concerns please make an appointment with our Nurse.

About You

Please use this date format: DD/MM/YYYY.
If you don't provide an email address we won't be able to respond to you by email

Your Asthma Review

You have answered 'Never' to all of the above three questions

The answers you have provided indicate you may have well-controlled Asthma. These results will be reviewed by our Asthma nurse and if required you may be contacted to arrange any follow-up.

Please submit your form after answering the below questions.

You did not answer 'Never' to all of the above three questions

The answers you have provided indicate you may not have well-controlled Asthma. It is important that you now contact the Practice to arrange an appointment with one of our Asthma nurses to complete your Asthma Review.

Please submit your form after answering the below questions.

Smoking Review

Do not currently smoke section

Do currently smoke section

Do you want to stop smoking? Here is some advice on ways to quit smoking, local services and general tips: www.nhs.uk/smokefree.

Also visit www.smokefreelifeoxfordshire.co.uk for advice and support and stopping smoking

Smoking leads to health problems such as cancer, heart disease and strokes. The benefits of stopping smoking includes: better health, more money and cleaner air for those around you!

Please note that the details you give will be used to update your medical records.