FeNO Screening

Form

Request an Appointment for a FeNO test

Please submit this form to request an appointment for a FeNO test. To help make sure your test results are accurate, please follow these instructions. The day before your appointment, please do NOT drink alcohol and do NOT smoke or vape. Try to AVOID being around second-hand smoke as well. Before your appointment, please watch this education video about how to perform the FeNO correctly during the appointment. Video: https://www.youtube.com/watch?v=G8ae24arxv8

Please complete this section if you are completing the form on behalf of someone else.

About You (The Patient)

Name  Required
Date of Birth  Required
Address  Required

Appointment Details

Why are you booking this FeNO test?  Required

Is this your first time having this test?  Required
Do you use an inhaler every day?  Required

Before Your Appointment

Do you understant that you should not drink alcohol the day before your FeNO breathing test?  Required
Do you understand that you should not smoke or vape the day before your FeNO breathing test?  Required
Do you understand that you should avoid eating, exercising, and drinking coffee or energy drinks for one hour before your appointment?  Required
Have you watched the video that shows how to perform the FeNO breathing test, or you will watch it before my appointment.  Required
Privacy Protection  Required

Before Your FeNO Breathing Test

To help make sure your test results are accurate, please follow these instructions before your appointment.

The day before your FeNO breathing test, please do not drink alcohol and do not smoke or vape. If possible, try to avoid being around second-hand smoke.

Before your appointment, please watch the short video that explains how to perform the FeNO breathing test. This will help you feel more comfortable on the day.

On the day of your appointment, please do not eat, exercise, or drink coffee or energy drinks for one hour before your test.

You may drink water during this time.

Continue taking your regular medications unless your doctor has told you otherwise.

The FeNO test is quick and painless and involves slow breathing into a mouthpiece.

Video

More Information

https://www.asthmaandlung.org.uk/symptoms-tests-treatments/tests/feno-test 

https://www.niox.com/feno-test

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