COPD
Many thanks for taking the time to complete this form about your COPD.
The information that you provide on this form will be passed to a clinician, who will review your responses and get in touch with you if there are issues that require follow up.
For each item below, select the closest option that best describes your current situation. For example, if you cough for about half the days of the week you might select 3 for the first question.
COPD
Do you smoke (cigarettes, cigars and vaping). If yes, then how many a day. If you quit, tell us how many you used to smoke and when you quit.
Alcohol units per week
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This information is retained for up to 28 days.
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please use one of the alternative methods offered by our organisation.