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Springfield Medical Centre NHS GP Surgery in Eccles

Breathlessness review

Breathlessness Review

Required fields are labelled

What is your name? Required

First name

Last name

What is your date of birth? Required

For example, 31 3 1980

Day

Month

Year

What is your sex? Required

As recorded on your medical record

Male

Female

Other

What is your postcode? Required

The one used to register with your GP

What is your phone number? Required

What is your email address? Required

Anyone else with access to your email account may see responses sent to you

Confirmation Required

Confirmation of consent for information about your/the patient’s health to be sent to the email address provided

Breathlessness Review

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

Confirmation Required

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

If you are human, leave this field blank.

This form has been turned off. It will be turned on again when the practice re-opens

To get the healthcare support you may need, please call us on 0161 871 2450, speak to your local pharmacist or contact NHS 111. You can also visit our online Treatment Room for self-help information on physical health requests or our online Wellbeing Centre for information about mental health services, including crisis support.

384 Liverpool Road
Eccles
Manchester
M30 8QD

Get directions

0161 871 2450