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.

About You

Full Name: *

Phone Number:

Please 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 100 yards or after a few minutes of walking on level ground

I’m 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 public are being reminded by NHS England that everyone accessing or visiting healthcare settings must continue to wear a face covering and follow social distancing rules. Covi... Find out more

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Please note that on and after 19th July 2021 we will still be asking patients to wear a mask or face covering if entering our premises. Wearing of a mask is still expected in a ... Find out more

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Please note on the following dates the reception desk will be closed due to staff being on duty at the Covid Vaccination Site at Saints Rugby Ground. On these dates/times listed... Find out more

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All GP practices have been, and continue to be, open - caring for St Helens patients, but in a different way. Read our information about what you need to do if you think you need a... Find out more

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Do you have a Learning Disability? Book in for your Annual Health Check today! If you have a learning disability and have joined your GP Practice’s register of people with a le... Find out more

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Breathlessness Review