Asthma Review Aged 4 - 11

This form is used for your child's annual asthma review. Please answer the questions and submit this form to us. This review will provide a score that may help your doctor determine if your child's asthma treatment plan is working or if it might be time for a change.

Should your child need help to complete this form, please visit our asthma page to access our user guide. 

Last Updated: 11/12/2024

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Asthma Review

Please let your child respond to the following questions. If your child needs help reading or understanding the question, you may help, but let your child select the response. There are no right or wrong answers.





Asthma Review

Please answer the following questions on your own and without letting your child's response influence your answers.




Before you complete this review, please answer the following questions





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