Asthma Pre-review

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 for your asthma or need medication urgently, please submit the form and contact the surgery in the normal way. If you need urgent medical attention when the surgery is closed, please ring 111.

Your Details

Please use this date format: DD/MM/YYYY.
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.

Adult Asthma Control Test

Child Asthma Control Test - Child to Answer

Child Asthma Control Test - Parent/Guardian to Answer

Additional Questions

Please contact LiveWell Dorset on 0800 8401 628 or visit www.livewelldorset.co.uk
An exacerbation is where your symptoms got worse, your reliever did not help and you needed to seek medical attention.
We will prescribe you a peak flow meter – please collect from your nominated pharmacy with your next prescription. Please see www.asthma.org.uk/peak-flow for information on peak flow meters.

When you have collected your meter, please send your best peak flow reading to quarterjack.surgery@nhs.net with your full name and date of birth.

Please check your inhaler technique here: www.asthma.org.uk/advice/inhaler-videos
Please note that the details you give will be used to update your medical records. Most people with well-controlled asthma will only need a face to face asthma review once every 3 years. We will advise you if you need to attend or not - if you have not heard from us within 28 days, please contact us.

During the Covid-19 pandemic, we are reviewing most patients by telephone – you will be advised if you need to book a telephone consultation with the asthma nurse or doctor.