Tell us the impact Coronavirus has had on your wellbeing

Please take five minutes to tell us how the Coronavirus outbreak is affecting your health and care needs.

We are collecting this data to understand what information and support local people need about Coronavirus.

Please share this link with your friends and family so we can help as many people as possible.

All your personal information is treated confidentially and anonymous in reports, in line with data protection laws. What this means is we keep it under lock and key, we won’t share your personal details with anyone else, and we get rid of them when we’re done.

The closing date for responses is Thursday 11th June 2020.

1. Are you happy for the information you give us to be stored and used this way? *


2. What are the main issues affecting you in relation to your health and well-being during the Coronavirus outbreak?


3. Have you experienced any changes to your healthcare due to the Coronavirus outbreak?


4. If yes, were these changes clearly communicated to you?


5. Are you finding the information you need during the Coronavirus outbreak?


6. Where have you found information or advice about Coronavirus?


7. Are you finding the support you need during the Coronavirus outbreak?


8. As time goes on, is there any support or information you think you will need moving forward?


9. Have you received a letter or text message asking you to shield yourself from Coronavirus?


10. We are keen to collect some stories from people about positive things that the have experienced during the Coronavirus outbreak. Do you have a positive story you want to share?


11. If so, are you happy for us to use this story anonymously within our publication materials?


12. Please help us learn a little bit more about you to ensure that we are reaching all members of the local community.

Do you consider yourself:


13. How old are you?


14. What is your ethnic origin?

  • Asian/Asian British
  • Black/Black British
  • Mixed/Multiple ethnic groups
  • White
  • Other ethnic group

15. Do you identify as:


16. Do you consider yourself disabled?


17. Are you a carer?


18. Which religion, if any, do you follow:


19. What is your employment status?


20. Would you like to sign up to our newsletter to keep up to date about this project and the other work we do?


21. What are the first three letters of your postcode? (e.g. EN4)

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