Pulmonary Risk Assessment

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Pulmonary Risk Assessment
The questions below help indicate how much risk you may have for developing COPD, emphysema, chronic bronchitis, or other pulmonary diseases. Please complete the form as accurately as possible. All of your information will remain completely confidential.

Submission Authorization
Please enter your contact information below to receive the results of your risk assessment. Any information submitted will not be shared with any person or organization. If you do not feel comfortable submitting this information, you are welcome to print out this sheet. We recommend discussing these questions with your primary care provider, especially if you have any health concerns related to your breathing.