|
|
|
|
|
What is your marital status? |
| |
|
|
|
|
|
|
Which category best describes your annual income? |
| |
|
|
|
|
How many children do you have with asthma? |
| |
|
|
|
|
How often are visits to the doctor/hospital for asthma? |
| |
|
|
|
|
How many asthma inhalers do you have? |
| |
|
|
|
|
How doe's your child/you keep up with the inhaler? |
| |
|
|
|
|
In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at school, or home? |
| |
|
|
|