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Asthma Questionnaire

Your Details

Questionnaire

If you are NOT, did you know there is an online demonstration on the Asthma UK website or you could pop in and see our practice nurse for more advice.

Smoking History

Privacy Protection

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.

Fields marked with an asterisk (*) are mandatory