If you’re coming in for an asthma evaluation for your child, or if you know your child has asthma but it is your first asthma visit at RBK, please fill out the following two forms before your visit:
Bayside Asthma History Questionnaire:This form asks basic questions about asthma history, symptoms, and treatments.
Bayside Asthma Trigger Questionnaire:Children Adults This form screens for environmental triggers of asthma and should be completed once per year. If symptoms have changed or you suspect something in the environment has changed your asthma, fill out the form again.
Asthma Control Test (ACT) Questionnaire:ages 4-11, English or Spanish; ages 12+, English Spanish This questionnaire helps us assess asthma control over the past four weeks. Please complete this form before your visit.
Asthma Check Ups
We recommend regular asthma check up visits twice a year and follow-up visits after any hospital visit for asthma, and after medications have been changed to assess results.
