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Rockford Pulmonary Clinic

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By entering your full name, email address, and phone number, you are providing personal information that will be used by Rockford Pulmonary Clinic for the sole purpose of returning your request to be contacted by us. We will only use this information to contact you in order to assist you in scheduling an appointment, and/or to answer any questions you may have indicated in the comments section. Our intention is to only use your personal information to return your request for contact regarding an appointment, and/or a lung health related question.

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Get In Touch!

We’re here to help you breathe easier and live better. If you have questions or concerns about your respiratory health, or if you’d like to schedule an appointment with Dr. Nafsi , please don’t hesitate to us. We look forward to hearing from you and serving your pulmonary care needs.

Lung Cancer

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This questionnaire will ask a series of questions about your asthma symptoms over the last 4 weeks.

Who are you taking this test for?

How to take the Asthma Control Test™


Step 1
Answer the five questions asked. For each question, make sure you read all five possible answers before choosing the best one for you.

Step 2
Complete the test by clicking 'SUBMIT.'

Step 3
If your score is 19 or less, talk to your physician for better control of Asthma.
01

In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?

0
02

During the past 4 weeks, how often have you had shortness of breath?

0
03

During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?

0
04

During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?

0
05

How would you rate your asthma control during the past 4 weeks?

0

Epworth Sleepiness Scale

Screen for excessive sleepiness or follow response to treatment for a sleep disorder
About:

Please answer the questions to the best of your ability. This will give us a score which is suggestive of excessive sleepiness. 

01

Chance of dozing off while sitting and reading?

0
02

Chance of dozing off while watching TV?

0
03

Chance of dozing off while Sitting, inactive in a public place?

0
04

Chance of dozing off as a passenger in a car for an hour without a break? ?

0
05

Chance of dozing off while lying down to rest in the afternoon when circumstances permit?

0
06

Chance of dozing off while sitting and talking to someone?

0
07

Chance of dozing off while sitting quietly after lunch without alcohol?

0
08

Chance of dozing off while in a car, while stopped for a few minutes in traffic?

0

Lung Cancer Screening

“*” indicates required fields
(2 packs per day for 10 years OR 1 pack per day for 20 years)

If you answered yes to all three questions, you are at high risk for lung cancer. Please contact your doctor for lung cancer screening CT chest or call RPC to schedule one.