Summervale Surgery

Canal Way, Ilminster, Somerset, TA19 9FE

Telephone: 01460 52354 (Surgery) / 01460 53049 (Dispensary)

Sorry, we're currently closed. Please call NHS 111

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Asthma Control Assessment Test

A member of the clinical team may ask you to complete this form prior to your Asthma review.

Name
DD slash MM slash YYYY
Question 1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
Select one checkbox only
Question 2. During the past 4 weeks, how often have you had shortness of breath?
Select one checkbox only
Question 3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
Select one checkbox only
Question 4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?
Select one checkbox only
Question 5. How would you rate your asthma control during the past 4 weeks?
Select one checkbox only
This field is for validation purposes and should be left unchanged.

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Opening Times (Surgery)

  • Monday
    08:00am to 08:00pm
    Surgery doors open 8.30am - 8pm. Phone lines 8am- 6pm
  • Tuesday
    08:00am to 06:30pm
    Surgery doors open 8.30am - 6.30pm. Phone lines 8am- 6pm
  • Wednesday
    08:00am to 06:30pm
    Surgery doors open 8.30am - 6.30pm. Phone lines 8am- 6pm
  • Thursday
    08:00am to 06:30pm
    Surgery doors open 8.30am - 6.30pm. Phone lines 8am- 6pm
  • Friday
    08:00am to 06:30pm
    Surgery doors open 8.30am - 6.30pm. Phone lines 8am- 6pm
  • Saturday
    CLOSED
  • Sunday
    CLOSED

Useful Links

NHS Choices
NHS 111
Patient UK
NHS A-Z Conditions
Find Local Services
Live Well
SurgeryWeb

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