COPD Review Form

If you have been scheduled for a COPD review – you may have been asked to complete a CAT review form. Please complete the following form which shall be forwarded to the practice. Please note that video consultations are not currently available.

COPD Review
Enter Email
Please use format day/month/year e.g. 12/05/1979

COPD Review

e.g. 65 kg
How Breathless are you? *
Do you smoke? *
You can buy a saturation monitor cheaply online
How many times have you been admitted to hospital this year with your chest? *
How many courses of antibiotics and steroids have you had in the last year for your COPD? *
Do you have a COPD self management plan at home? *
Do you have standby antibiotics and steroids in the house as part of your treatment plan? *
Do you have standby antibiotics and steroids in the house as part of your treatment plan? *
One of our clinicians will contact you on this number in the next couple of weeks.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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