Asthma Control Form

Asthma Control Form
Please use date format DD/MM/YYYY

Asthma Control

If your score is 19 or less, your asthma may not be under control.
Please complete this form and also book for your annual review.

Flu Vaccination

Annual Flu Vaccination is recommended for all patients with severe asthma (this excludes patients under 6 months of age and those who need occasional reliever inhaler only).

Informed Dissent

It is strongly recommended that any person with a long term health condition should receive regular care and follow up. If however, against our advice you decide that you do not wish to attend for an annual review this year, then we would be grateful if you would read and tick the box below. A routine reminder for your annual review will be sent to you in a year's time and you are welcome to make an appointment for a review at any time should you change your mind.