Brief Respiratory Questionnaire (BRQ) - Hudson Valley Asthma - hudsonvalleyasthmacoalition 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the interviewer's name and the date of the interview at the top of the form.
3. Fill in the child's first name, last name, date of birth, and ethnic group. Ensure you select all applicable options.
4. Provide details about the parent or guardian, including their first name, last name, and relationship to the child.
5. Answer questions regarding the child's respiratory health over the past 12 months. For each question, select 'Yes' or 'No' as appropriate and provide numerical responses where indicated.
6. If applicable, complete any additional information requested for conditions diagnosed by a healthcare provider.
7. Review all entries for accuracy before submitting your completed questionnaire.

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