Patient Lung Survey

Do you need to see a doctor about your lung health?

Please complete the following survey to help determine your lung health. You can take the survey results to your doctor to request a referral to NBST for highly experienced care.

Lung Health Survey

The results will be emailed to the supplied email address. Discuss the results with your doctor and request a referral to NBST.

Lung Function Survey

"*" indicates required fields

Have you noticed a new or persistent cough, or a cough that has changed?*
When coughing, do you produce phlegm, mucus, or blood, or do you have blood in your phlegm or mucus?*
Do you have recurrent chest infections?*
Do you find yourself constantly feeling tired without an explanation?*
Have you experienced unexplained weight loss?*
Do you often feel out of breath without explanation (unexplained breathlessness without exercise, etc.) compared to people your age?*
Do you experience chest tightness or wheezing, especially when you breathe?*
Do you experience chest pain often, especially when you breathe?*
Do you currently smoke, or have you previously smoked?*
Have you previously or currently been exposed to continuous dust, gas, or fumes from your workplace or any other environment?*
Name*

Contact us to book an appointment

Visit us at either our Clayfield or North Lakes location and experience compassionate care in a comfortable environment, tailored to meet your unique needs.

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