Asthma Home Visit Questionnaire

Sponsoring Program Name: 
Boston Public Health Commission

Asthma Home Visit Questionnaire from the Boston Public Health Commission


This is a PDF printout of a form that was developed and lives in an online program called REDCap. REDCap is a free and secure online portal through which survey instruments and templates can be created and data can be securely stored.  Several questions on the online form are prepopulated with multiple choices or drop-down menus. The PDF version prints all options listed for every question.  It is recommended that anyone looking to adapt this tool prioritize their questions and determine the most suitable questionnaire format. If you have REDCap, we may be able to share the Data Dictionary (online template) for this questionnaire with you.  Please direct any questions related to this questionnaire to

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