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Asthma review (aged 11 and under)

Asthma review – Aged 11 and under

How often does your child’s asthma cause symptoms during the day?
How often does your child’s asthma cause symptoms at night?
How often does your child’s asthma limit their activities?
Does your child’s asthma have any specific triggers?
What triggers your child’s asthma?
Select all that apply.

Childhood Asthma Control Test

Please have your child complete the next 4 questions. You can help your child with reading and understanding the questions but should allow your child to answer them on their own.

Please answer the next 3 questions on your own, do not let your child’s answers influence how you answer this question

This is automatically calculated and will be sent to the practice upon submission.
Is your child regularly exposed to second hand smoke?
Do you know what inhalers your child uses to treat their asthma?
Do you know what to do if your child’s asthma gets worse, or they have an asthma attack?
Are you happy for your child’s asthma review to be marked as complete?

What happens next?

Once you click submit below, this form will be submitted to the practice and passed onto our asthma team to review. Depending on your answers they will either:

  • Mark your child’s asthma review as complete
  • Ask reception to contact you to arrange an appointment

To ensure that your child has a full asthma review at least once a year, you will be asked to complete this every year during your child’s birth month.