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Park Royal Medical Practice
Menu
Home
About Us
Contact
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Website
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Brent Weight Management Schemes and Services
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Park Royal Medical Practice
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Asthma Control Test
>
Adult Control Test for Adult 12+ years
Adult Control Test for Adult 12+ years
Asthma Control Test – Adult
First Name
*
Last Name
*
Email
*
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Control Test Questions
During the last 4 weeks, how much of the time has your asthma kept you from getting as much done at work, school or home?
*
All of the time – 1
Most of the time – 2
Some of the time – 3
A little of the time – 4
None of the time – 5
During the last 4 weeks, how often have you had shortness of breath?
*
More than once a day – 1
Once a day – 2
3-6 times a week – 3
1-2 times a week – 4
Not at all – 5
During the last 4 weeks, how often have your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) woken you up at night or earlier than usual in the morning?
*
4 or more times a week – 1
2-3 nights a week – 2
Once a week – 3
Once or twice – 4
Not at all – 5
During the last 4 weeks, how often have you used your rescue inhaler or nebuliser medication?
*
3 or more times a day – 1
1-2 times a day – 2
2-3 times a week – 3
Once a week or less – 4
Not at all – 5
How would you rate your asthma control during the last 4 weeks?
*
Not controlled – 1
Poorly controlled – 2
Somewhat controlled – 3
Well controlled – 4
Completely controlled – 5
If you are human, leave this field blank.
View Your Score
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Home
About Us
Contact
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Website
Regulations & Governance
Teenage Friendly
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Brent Weight Management Schemes and Services
Clinics
GP Access Hubs
Saturday Clinic
Travel Clinic & Holiday Vaccinations
Online Services
Patient Record
Learn My Way
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Help & Support
News