How to Use This Form

Ensure that you complete all steps of this form to successfully submit your asthma review.

Please note that this facility is ONLY for telling us about your asthma, and ONLY for patients who are registered with our practice. You should contact the surgery to tell us about any other changes.

You will receive a notification email to your inbox confirming that the review has been sent successfully. If you do not receive a confirmation, please check your Junk or Spam email folders before contacting the Practice.

Only complete this questionnaire if you have been invited to do so by the practice.


Our Asthma Review Questionnaire form is encrypted and secured by a 128bit SSL certificate, and sends your request information in the content of an email. Although this is sent ONLY to the Practice, we are unable to guarantee complete privacy during the transmission.

If you have any concerns with regards to using this service, please speak to the Practice about other methods of telling us about changes to your details.

For repeat prescription orders and appointments, you will need to sign up to our My Health Online service.

What is GDPR?

The EU General Data Protection Regulation (GDPR) is the most important change in data privacy regulation in 20 years. GDPR fundamentally reshapes the way in which data is handled across every sector, from healthcare to banking and beyond.

As part of our data privacy obligations, we have to ensure that when we collect information about you that we are fully compliant with GDPR. For more information, please see the Guide to the General Data Protection Regulation (GDPR) article on the ICO website .