COPD Review Form

This form is used for your annual COPD review. Please answer the questions and submit this form to us. If your symptoms are deteriorating or you have any concerns, please make an appointment to see the respiratory nurse or a Doctor.

Last Updated: 15/12/2021

Conditions of Use

Your Details

Blood Pressure


COPD Assessment Test (CAT)

Please answer each question by giving a score from 0-5

Breathlessness Review

Please be aware that a nurse may contact you to discuss your COPD review



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