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  • 01952 201144
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Hollinswood & Priorslee Medical Practice Providing NHS services
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Home > Asthma Review

Asthma Review

Please complete this form if you are due your annual Asthma review.

If your symptoms are deteriorating or you have any concerns, please make an appointment to the respiratory nurse or a doctor as well.

Your Details

DD/MM/YYYY
Find my NHS Number (opens in new window)
Your Contact Details

Review Questions
Have you had difficulty sleeping because of your asthma symptoms (including cough)?
Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness or breathlessness)?
Has your asthma interfered with your usual activities (e.g. housework, work/school etc)?
If you are having any symptoms have you noticed a specific cause or causes?
Have you found anything which helps to relieve your symptoms (apart from your medication)?
Are you having any problems using your inhaler?
Do you smoke?

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All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Hollinswood Surgery

Downemead , Hollinswood, Telford, Shropshire, TF3 2EW

  • 01952 201144

Holliwell

Deercote, TF3 2BH

  • 01952 293949

Priorslee Surgery

Glen Cottage, Priorslee, Telford, Shropshire, TF2 9NW

  • 01952 299521
  • hollinswood.ooh3@nhs.net
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