Provide Asthma Screening

Asthmatic Patient Annual Screening Questions

This form is for patients who already have a diagnosis of asthma. If you have not been diagnosed with asthma, but suspect you may have it, please make an appointment to see your doctor rather than using this form.

We aim for the asthma nurse to review your answers within three working days, but at busy times it may take longer.

Once a year please select the surgery you are from below and fill in the form. If you answer “yes” to any of the questions you are encouraged to book an Asthma Review.

St Thomas Health Centre or Pathfinder Village Surgery

* = Information must be provided


Exwick Health Centre

* = Information must be provided