If you have been advised by the surgery to submit an annual review of your asthma symptoms please use this form. If your symptoms are significantly deteriorating or you are having any concerns please make a telephone appointment with our Nurse.
You may have received a text or a letter. This is because asthma reviews are an essential way of monitoring your symptoms and ensuring your medication is safe and appropriate.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
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.
I consent to my information being used for the purposes described above and wish to submit this online form to
Croft Medical Centre
Calder Walk, Leamington Spa, CV31 1SA.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.