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Available Forms

ACT 4 to 11 years
First & Last
Patient's DOB

Parent or Guardian: The Childhood Asthma Control Test* is a way to help your child?s healthcare provider determine if your child?s asthma symptoms are well controlled. Childhood Asthma Control Test for children 4 to 11 years Take this test with your child (ages 4 to 11). Share the results with your child?s healthcare provider. Step 1: Have your child answer the first four questions (1 to 4). If your child needs help, you may help, but let your child choose the answer. Step 2: Answer the last three questions (5 to 7) on your own. Don?t let your child?s answers influence yours. There are no right or wrong answers.


Have your child complete these questions.


Please complete the following questions on your own.

* Required field