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Do you suffer from asthma or a respiratory condition

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Do you suffer from asthma or a respiratory condition Powered By Docstoc
					                                                                                                                                                         www.islington.gov.uk


                                                                                                                                                         Do you suffer
                                                                                             If you would like this document
                                                                                             in large print or Braille, audiotape
                                                                                                                                                         from asthma
                                                                                             or in another language, please                              or a respiratory
                                                                                             contact 020 7527 2000.
                                                                                                                                                         condition?
                         Public Protection Division
                                                 Islington Council
                                                                159 Upper Street
                                                                               LONDON
                                                                                    N1 1RE
BUSINESS REPLY SERVICE




                                                                                             Contact Islington
                                                                                             222 Upper Street
                                                                                             London N1 1XR                                               Sign up to Islington airTEXT and receive
                                                                                             E contact@islington.gov.uk                                  free air pollution alerts sent direct to your
Licence Number




                                                                                             T 020 7527 2000
                                                                                             F 020 7527 5001
                                                                                                                                                         mobile, email or home phone
                                                                                             Minicom 020 7527 1900
                                                                                             W www.islington.gov.uk
ND1765




                                                                                             Printed on 70% recycled paper using vegetable based inks.
                                                                                             Printed March 2007.
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About airTEXT
                                                                                         To register for airTEXT please complete the following in BLOCK CAPITALS and return the completed
Air pollution can cause short-term health effects to                                     form by post.
sensitive individuals including those who suffer from                                    All of your answers and personal data are confidential and will not be shared with any organisation outside of
heart disease or lung diseases such as asthma. But                                       the airTEXT consortium.
minimising exposure to air pollution and adjusting
medication can reduce the effects.
                                                                                         Name (including title, forename and surname)
By signing up to Islington airTEXT you may be able
to help to manage the symptoms of your condition.                                        I would like to receive airTEXT alerts for me                                                for my child                      or someone I look after
You can choose to receive a free alert on the evening                                                                                                                                                             DD/MM/YYYY
before or the actual morning of days when elevated air                                   Your date of birth (or date of birth of person the alerts are for)
pollution is forecast.                                                                   Address in Islington (including postcode) for which the alerts are required (e.g. your home, your work place,
Islington airTEXT alerts can help you to manage your                                     your child’s school)
exposure to air pollution when levels are moderate or
                                                                                         ..............................................................................................................................................................................................................
high. However you should always contact your doctor if




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                                                                                                                                                                                                                                                                                                          Moisten gummed edge to seal
you are worried about any aspect of your condition.                                      ..............................................................................................................................................................................................................
airTEXT via your mobile phone
                                                                                         Email address
Get airTEXT alerts via your mobile phone and you’ll
receive a text message with the predicted air pollution
details plus brief information about symptoms and                                        I would like to receive:
health advice.
                                                                                         Alerts to the above email address
airTEXT via your home phone
                                                                                         OR text messages sent to my mobile phone number
Get airTEXT alerts via your home phone and you’ll
receive a recorded spoken message with the predicted                                     Please send my alerts at (please tick just ONE):
air pollution details plus brief information about
symptoms and health advice.                                                              6-7pm the evening before a high pollution day                                                           7-9am the morning of a high pollution day
airTEXT via your email                                                                   I would be interested in receiving airTEXT alert recorded messages sent to my home phone number
Get airTEXT alerts via your email and you’ll receive an
update sent to your home or work account with the
predicted air pollution details plus brief information
about symptoms and health advice.                                                        From which of the following medical conditions do you or the person the messages are intended
                                                                                         for suffer from?
And remember whichever message you choose,
Islington airTEXT is completely free of charge. For more                                 Asthma                    Bronchitis                     Emphysema or COPD                                    Heart disease or angina                                 Other
information and to register visit www.airtext.info or
complete the attached form and post it back today.
                                                                                         Signature............................................................................................................................................................................................

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Description: Do you suffer from asthma or a respiratory condition