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An asthma review is a yearly appointment with your GP or asthma nurse. If you’re free of symptoms, your review helps you stay that way.

Completing this form helps us decide whether you need to come in for an asthma review or not.

Please take a moment to look at www.asthmaandlung.org.uk for advice on managing your asthma.

Fields marked with a red asterisk are compulsory. *

Patient's details

How well is your Asthma controlled?

Daytime symptoms more than twice/week?
Any night waking due to asthma
Reliever needed more than twice/week?
Any activity limitation due to asthma?
Do you feel your asthma is well controlled? (Do you think your medicine is working?)
Have you needed oral steroid medication in the last 12 months?
These are usually small tablets, 6 to 8 taken at the same time for 5 to 7 days

Taking your inhalers

In an average week, how many times do you forget to take your preventer medication?
Preventer medication is your regular inhaler

Further information

Smoking status

 

City View Medical Practice
Beeston Hill Community Health Centre
123 Cemetery Road
Beeston 
Leeds  
LS11 8LH (for satnav use LS11 8BS)
Tel 0113 467 7515

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Shafton Lane Surgery 
20A Shafton Lane
Holbeck
Leeds 
LS11 9RE
Tel 0113 467 7515

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Opening hours
Monday-Friday 8.00am - 6.30pm