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Asthma Pre-Review form

This form is to be used as a pre check for your routine asthma review, to decide if you need further assessment. If you feel that you need urgent medical attention, please contact the surgery in the normal way. If you need urgent medical attention when the surgery is closed, please ring 111.

For patients aged under 12, please contact the surgery for a review appointment.

About you:

Please provide at least one contact number or email address. By providing a mobile phone number and/or email address on this online form, we assume consent to reply by this method.

Your Asthma Review

If you smoke but are interested in quitting You are far more likely to have a successful quit attempt if you attend an NHS Stop Smoking Service. The local chemists Co-op, Day Lewis and Boots offer a free Stop Smoking Service where they will offer you advice, prescriptions and a non-judgemental approach, giving support to help you quit. The adviser will discuss NHS-endorsed treatments available to help you stop smoking. These are nicotine replacement therapy – including patches, gum, lozenges, microtabs, inhalators and mouth sprays – and the stop smoking tablets Champix (varenicline) and Zyban (bupropion). For more information please contact them direct.

Online Access to smoking advice – You might also be interested in online resources such as the NHS smoke free: https://www.nhs.uk/smokefree which includes personalised quit plans and App downloads.

Please note that the details you give will be used to update your medical records. We will advise you if you need to attend or not. If your symptoms are well controlled and we do not contact you we will cod your records as ‘annual review done’.

Please do not hesitate to contact us if your symptoms change. If you feel that you need urgent medical attention, please contact the surgery in the normal way. If you need urgent medical attention when the surgery is closed, please ring 111.


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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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.


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