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Millrise Medical Practice
Menu
Home
About Us
Contact
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
What is a PCN or Primary Care Network and how does it benefit you as a patient?
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Website Policies
Regulations & Governance
Teenage Friendly
Training Practice
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Book your Blood Test Appointment
Travel Clinic & Holiday Vaccinations
Clinics
Importance of Immunisations
Adult Immunisations
Baby Immunisations
Recommended Vaccinations in Pregnancy
School Age Vaccinations
Travel Vaccinations
Online Services
Patient Record
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Awareness Topics
January 2024
World Religion Day
Dry January
February Focus
Rare Disease Day
LGBT+ February Awareness Month
Time to Talk Awareness Day
World Cancer Day
Eating Disorder Awareness Week
March Focus
World down Syndrome Day
National No Smoking Day
Ovarian Cancer Awareness Month
World Oral Health Day
World Kidney Day
Zero Discrimination Day
April Focus
Stress Awareness Month – April
Bowel Cancer Awareness Month 2024
Lesbian Visibility Week
Autism Acceptance Week
May Focus
Mental Heath Awareness Week
International Nurses Day
Sun Awareness Week
Take to Your Feet
June Focus
Armed Forces Day
World autistic Pride Day
Pride month – June
Learning Disability Week
Cervical Screening Awareness Week
Blood Donor Day
July Focus
Alcohol Awareness Week
Group B Strep Support Month
Sarcoma Awareness Month
Samaritans Awareness Day
Schizophrenia Awareness Day
National Bereaved Parents Day
World Hepatitis Day
August Focus
World Breastfeeding Week (WBW)
Makaton International Awareness Day
September Focus
International Day of Sign Language
Blood Pressure UK
World Sepsis Day
World Donation Week
World Suicide Prevention Day
October Focus
World Mental Health Day
Black History Month
Go Sober for October
Breast Cancer Awareness Month
Stoptober
World Menopause Day
November Focus
Trans Awareness Week
Anti-Bullying Week
Movember
December Focus
World Aids Day
International Day of People with Disabilities
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News
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Millrise Medical Practice
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Health Review Forms
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Asthma Control Test
>
Adult Control Test for Adult 12+ years
Adult Control Test for Adult 12+ years
Asthma Control Test – Adult
First Name
*
Last Name
*
Email
*
Date of birth
*
Please use format day/month/year e.g. 12/05/1979
Phone Number
*
Control Test Questions
During the last 4 weeks, how much of the time has your asthma kept you from getting as much done at work, school or home?
*
All of the time – 1
Most of the time – 2
Some of the time – 3
A little of the time – 4
None of the time – 5
During the last 4 weeks, how often have you had shortness of breath?
*
More than once a day – 1
Once a day – 2
3-6 times a week – 3
1-2 times a week – 4
Not at all – 5
During the last 4 weeks, how often have your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) woken you up at night or earlier than usual in the morning?
*
4 or more times a week – 1
2-3 nights a week – 2
Once a week – 3
Once or twice – 4
Not at all – 5
During the last 4 weeks, how often have you used your rescue inhaler or nebuliser medication?
*
3 or more times a day – 1
1-2 times a day – 2
2-3 times a week – 3
Once a week or less – 4
Not at all – 5
How would you rate your asthma control during the last 4 weeks?
*
Not controlled – 1
Poorly controlled – 2
Somewhat controlled – 3
Well controlled – 4
Completely controlled – 5
If you are human, leave this field blank.
View Your Score
Close
Home
About Us
Contact
Have your Say
Making the most of your Practice
Meet the Team
Doctors
Nurses
Practice Team
Our Allied Health Professionals
What is a PCN or Primary Care Network and how does it benefit you as a patient?
Practice Policies
At the Practice
Data
Patient Record
Patient Rights
Website Policies
Regulations & Governance
Teenage Friendly
Training Practice
Clinics & Services
Appointments, Tests & Referrals
Appointments
Referral for Further Care
See a Doctor or Healthcare Professional
Tests & Investigations
Book your Blood Test Appointment
Travel Clinic & Holiday Vaccinations
Clinics
Importance of Immunisations
Adult Immunisations
Baby Immunisations
Recommended Vaccinations in Pregnancy
School Age Vaccinations
Travel Vaccinations
Online Services
Patient Record
Register for Online Services
NHS App
Practice Services
Forms
Keep us up to Date
Health Review Forms
Awareness Topics
January 2024
World Religion Day
Dry January
February Focus
Rare Disease Day
LGBT+ February Awareness Month
Time to Talk Awareness Day
World Cancer Day
Eating Disorder Awareness Week
March Focus
World down Syndrome Day
National No Smoking Day
Ovarian Cancer Awareness Month
World Oral Health Day
World Kidney Day
Zero Discrimination Day
April Focus
Stress Awareness Month – April
Bowel Cancer Awareness Month 2024
Lesbian Visibility Week
Autism Acceptance Week
May Focus
Mental Heath Awareness Week
International Nurses Day
Sun Awareness Week
Take to Your Feet
June Focus
Armed Forces Day
World autistic Pride Day
Pride month – June
Learning Disability Week
Cervical Screening Awareness Week
Blood Donor Day
July Focus
Alcohol Awareness Week
Group B Strep Support Month
Sarcoma Awareness Month
Samaritans Awareness Day
Schizophrenia Awareness Day
National Bereaved Parents Day
World Hepatitis Day
August Focus
World Breastfeeding Week (WBW)
Makaton International Awareness Day
September Focus
International Day of Sign Language
Blood Pressure UK
World Sepsis Day
World Donation Week
World Suicide Prevention Day
October Focus
World Mental Health Day
Black History Month
Go Sober for October
Breast Cancer Awareness Month
Stoptober
World Menopause Day
November Focus
Trans Awareness Week
Anti-Bullying Week
Movember
December Focus
World Aids Day
International Day of People with Disabilities
Help & Support
News