Asthma Review Form

About You

Please use this date format: DD/MM/YYYY.

Asthma Score Card

Congratulations! You have Full Control of your asthma during the past four weeks. You have had no symptoms and no asthma-related limitations. See your doctor or nurse if this changes.

Your asthma may have been Well Controlled but not Fully Controlled during the past four weeks. Your doctor or nurse may be able to help you aim for Full Control.

Your asthma may Not Have Been Controlled during the past four weeks. Your doctor or nurse can recommend an asthma action plan to help improve your asthma control.

Asthma Review

N.B. Please ensure you list what you are actually using which may not necessarily be what you were prescribed