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COPD Online Review
Please complete your annual questionnaire in order to assist your doctor in how your condition is doing
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* Indicates required question
We need only 1 submission per YEAR unless you have been told by the surgery for more
Your Details
Please include your latest personal details so that we can contact you if necessary
Your Full Name
*
Your answer
Your Date of Birth
*
Please include your DOB in the form of DD/MM/YYYY i.e 01/01/1980
Your answer
Your MOBILE number
*
If we need to contact you to clarify your answers especially if your asthma is poorly controlled
Your answer
Your EMAIL address
*
If we need to contact you to clarify your answers especially if your asthma is poorly controlled
Your answer
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