ASTHMA CONTROL QUESTIONNAIRE

Package Contents

Asthma Control Questionnaire

Asthma Control Questionnaire (Interviewer-administered) for children 6-10 years

Asthma Control Diary

Background, Administration and Analysis (an implementation manual)

Reprints of published manuscripts describing the development, validation and interpretation of the ACQ, ACD.

List of languages

Response Card

ACQ Package ordering

Packages to Europe are sent by Airmail.

Packages to the rest of the world are sent by Surface Mail (about 8 weeks delivery)

If you live outside Europe and would like your package sent by courier, please include your courier number (e.g. FedEx or UPS ).

*Title :

*Name

*Organisation

*Address :

*Post Code/Zip :

*Country :

*Email :

Telephone no:

*Language(s)

Courier Number (e.g. FedEx, UPS , DHL)

Additional Comments:

* Please describe briefly the purpose for which you will be using the questionnaire

*Must be completed