Child Asthma Review (Age 4-11)

If your child (aged 4-11) has asthma, please submit this form.

Your healthcare provider can help you take appropriate action to better manage your asthma.

Child Asthma Review (Age 4-11)

Child Details

Please use date format: DD/MM/YYYY

Parent / Guardian / Carer's Details

Any responses we send will go to this email address.

How to answer the childhood asthma control form

Let your child answer the first four Asthma Control questions. If your child needs help reading or understanding the question, you may help, but let your child choose which answer he / she prefers. Complete the remaining three Asthma Control questions on your own without letting your child's response influence your answers. There are no right or wrong answers.

Asthma Control

Ask your child to complete these questions:

Please complete the following questions on your own:

Additional Questions

Do you have a personalised asthma action plan?
Since your child's last review, have they needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of their asthma?
Since your child's last review, have they needed a course of steroid tablets to get their asthma under control?


Please select the types of inhalers that you use:

Please watch these short video(s) on how to use your inhalers

Please let us know that you have watched and understood the video(s): *