Improved access for patients to GP appointments

Did you know…? We are participating in a new approach to improve access for patients to GP appointments. The aim is to direct patients to the most appropriate healthcare professional, which may be a GP or a pharmacist.

Fill out a simple online form to get advice and treatment by the end of the next working day.

Southfields Group Practice > Forms > Health Review Forms > COPD Review Form

COPD Review Form

We are offering a new telephone or video consultation for COPD review. If you would like to use this service please complete the electronic form below.

COPD Review

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Your Breathlessness Review

How do you rate your level of breathlessness? *

I’m 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 a few minutes of walking a short distance on level ground

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

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

I consent to the practice collecting and storing my data from this form.

Improved access for patients to GP appointments

COPD Review Form

Your Breathlessness Review

Privacy Policy

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