Grasmere Surgery

01942 483330

Asthma Review Questionnaire

For patients who are due an annual asthma review.

Please would you answer the questions on the form below and submit it 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.

  • If you know your latest blood pressure reading, please type it in this box.
  • if you know what your current weight is, please type it in this box.
  • Do you have any questions or concerns about your Asthma? If yes, please let us know in the box below, and we will get back to you asap.
  • If you are ready or thinking about stopping smoking for further information and support please access this link https://www.nhs.uk/smokefree.com