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Mount Road Surgery

Manchester

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Mount Road Surgery

Manchester

Breathlessness Review

If you have been advised by the surgery to submit breathlessness reviews on a regular basis, please use this form.

If you are human, leave this field blank.

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

It has been found to be beneficial for patients with breathlessness to undertake Pulmonary Rehabilitation programmes. You may already have done so. It consists of education about the disease and assistance with exercise.

Please select an option relating to the Pulmonary Rehabilitation programme:

I am interested in taking part in the programme

I have done the programme over 18 months ago and would like to do it again

I have already done the programme within the last 18 months

I am not interested at the current time