Please complete this form to allow our Practice Nurse to complete your annual asthma review. Please answer each question to the best of your knowledge and submit this to us. Your form will be added to your medical records and reviewed by the Practice Nurse who will only contact you if further management is required.
I wish to decline Asthma review. I understand the importance of this but do not wish to partake this year. I further understand that should I change my mind, I can complete this review at any time.
This form collects your name, date of birth, email and other personal information along with certain medical details. This is to confirm that you are a registered patient with Cowdenbeath Medical Practice to allow the Practice team to contact you to discuss the management of your medical care and also to update the records that we hold. For further information on how we protect and manage your submitted data please read our privacy policy.
Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to Cowdenbeath Medical Practice • 173 Stenhouse Street, Cowdenbeath, Fife, KY4 9DH.
Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.
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