Breathlessness Review

If you have been advised by the surgery to submit breathlessness review on a regular basis please use this form.

If you are human, leave this field blank.

Section

Have you received a letter advising you to complete this review?

Yes

Please specify requester and date of letter:

Please use date format DD/MM/YYYY.

Please rate your level of breathlessness:

I am not troubled by breathlessness

I get breathless when I undertake vigorous exercise

I get short of breath when hurrying or walking up slopes

When walking I have to stop from time to time or walk slower due to breathlessness

I have to stop for breath after 100 yards or after a few minutes of walking on level ground

I am too breathless to leave the house and get breathless when getting dressed

I confirm that the information provided is accurate to the best of my knowledge

Important -

The NHS Norfolk and Waveney Prescription Ordering Direct (POD) service is closing at the end of June 2024, with online ordering closing mid-April. For further information, pleas... Find out more

Important -

There is a new website called “FYI” for people aged 11 to 24 years old. It provides advice and information around health, school, friendships and more. Please take a look and ... Find out more

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Breathlessness Review