Asthma Review Form

This form is used for your annual asthma review. Please answer the questions and submit this form to us. If your symptoms are deteriorating or you have any concerns, please make an appointment to the respiratory nurse or a Doctor as well.

Last Updated: 26/03/2025

Your Details

Name *

Date of Birth *

Phone Number

Email Address *

Consent

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA *

I consent to the practice collecting and storing the data from this form

Asthma Review

Asthma Control Score

Inhaler Technique

Please click on the link below. This will lead you to a page with a short video on good inhaler technique. Please look through the list and click the inhaler you use

https://www.asthmaandlung.org.uk/living-with/inhaler-videos

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the Lammermuir Medical Practice website

Asthma Review Form

Further Information