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Asthma Annual Review Questionnaire 2017-18

You are due an 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 with one of our clinicians to discuss aswell as completing this form. 

1Contact Details

2Questionnaire

ml/min

If you are not, did you know there is an online demonstration on the Asthma UK website (https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers) or you could pop in and see one of our clinicians for more advice.

If 'Yes', please answer the following:


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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Walford Avenue, Worle, Weston-super-Mare, North Somerset, BS22 7YZ
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Your Neighbourhood Professionals. Just a Click Away! Need care but want to stay in your own home? Set up a lasting power of attorney before you lose capacity and it Home Tone Fitness New Dawn Counselling Service Ploughmans Farm Shop
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