Please fill out the questions below.
It will also be beneficial for us to see the results of your Asthma Control Test. If you are able, please save and attach them using the button on the right. To export your results, please click 'Save My Results', and then click 'View Results'. Save the PDF copy of your results and attach them below. If you are unable to attach your results, please continue with the other questions.
To help us to assess your asthma, we require you to fill out an asthma control test. Please visit the link on the right and complete the questionnaire. Once you have finished, please enter the numerical result in the box provided.
If your score is below 20, please make an appointment to speak to a nurse and form an asthma management plan.
How many times this year have you experienced exacerbations in your asthma?
Are you a smoker?
Do you currently have an asthma management plan agreed with your clinician?
If you chose 'No' in the above box, please refer to the Asthma UK website for information about managing your asthma and plans you can follow to help keep your symptoms in check:
Are there any other details you would like to add?