VISIT PATIENT SERVICES

Home » Give Us Your Clinical Data » COPD Assessment Test (CAT)

COPD Assessment Test (CAT)

Please complete the form and take the COPD Assessment Test

Name: *

Email: *

Date of Birth(DD-MM-YYYY): *

Phone:

Which Surgery are you registered at?

Coughing

0 = I never cough. 5 = I cough all the time.

0 1 2 3 4 5

Phlegm (mucus)

0 = I have no phlegm (mucus) in my chest at all. 5 = My chest is completely full of phlegm (mucus).

0 1 2 3 4 5

Chest

0 = My chest does not feel tight at all. 5 = My chest feels very tight.

0 1 2 3 4 5

Breathless

0 = When I walk up a hill or one flight of stairs I am not breathless. 5 = When I walk up a hill or one flight of stairs I am breathless.

0 1 2 3 4 5

Limited

0 = I am not limited doing any activities at home. 5 = I am very limited doing activities at home.

0 1 2 3 4 5

Confidence

0 = I am confident leaving my home despite my lung condition. 5 = I am not confident leaving my home because of my lung condition.

0 1 2 3 4 5

Sleep

0 = I sleep soundly. 5 = I don't sleep soundly because of my lung condition.

0 1 2 3 4 5

Energy

0 = I have lots of energy. 5 = I have no energy at all.

0 1 2 3 4 5

Time's up

Design by studio shinjin