Tools for providers:

Patient questionnaire

The Patient Questionnaire can be completed in the waiting room by patients with asthma when they come for an office visit. This questionnaire can help give information to a clinician during the annual asthma visit, or can be used for case management of high-risk asthma patients.

Color - download and print the pdf in color

Patient questionnaire (English)

Patient questionnaire (Spanish)

Patient questionnaire (Russian)

Patient questionnaire (Vietnamese)

Black and white - download and print the pdf in b/w

Patient questionnnaire (English)

Patient Questionnaire (Spanish)

Find more materials you can print...