1. Tell us your thoughts or experiences around Long COVID for a chance to win a store voucher!

Your feedback can change services and save lives.
We are working to learn more about people's experiences of living with Post COVID Syndrome (Long COVID) and the support that they may have received. We want to understand why some people are seeking support for their symptoms whilst others continue to manage their symptoms without any help. By completing this survey, you can help us offer services in the right way to the people that need it most.

It will only take a few minutes to complete the survey. As a thank you for taking the time to complete the survey, we will enter you into our prize draw. You could win a £50, £25 or £10 store voucher, simply by answering a few questions!

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We are happy to provide support to complete this survey. If you would like someone to call you to help complete the survey, please just leave your email or phone number below and we will be in contact. We will only use your email address/phone number to contact you about this survey.

Have you ever tested positive for COVID-19?

Yes

No

When did your COVID-19 symptoms start? (please enter an approximate date. We know not everyone will be able to tell us the exact day their symptoms started)

*

If you have had COVID-19 infection, did you seek medical support from any of the following?

Admission to hospital

Medical advice or treatment from GP

Medical advice from pharmacy services or minor ailments unit

Medical advice from NHS 111

No, I did not seek medical support

If you have had COVID-19 infection, did you seek medical support from any of the following?

Admission to hospital

Medical advice or treatment from GP

Medical advice from pharmacy services or minor ailments unit

Medical advice from NHS 111

No, I did not seek medical support

Have you ever been diagnosed with Long COVID?

Yes

No

Are you currently experiencing any of the following symptoms of Long COVID? (tick any that apply to you)

Fatigue

Difficulty in concentrating

Problems with memory

Shortness of breath

Muscle ache

Heart palpitations

Body pain

Other (please specify):

This is required

If you are experiencing Long COVID symptoms, are they impacting on your daily life? (please tick any of the following that apply to you).

have difficulty caring for my family,

I cannot work,

I have had to request my employer to make adjustments to my working role,

I cannot attend education,

I have had to take a break from work/education due to my symptoms,

I have difficulty in socialising with friends/family

Other (please specify):

This is required

1. Tell us your thoughts or experiences around Long COVID for a chance to win a store voucher!

We are happy to provide support to complete this survey. If you would like someone to call you to help complete the survey, please just leave your email or phone number below and we will be in contact. We will only use your email address/phone number to contact you about this survey.

Have you ever tested positive for COVID-19?

When did your COVID-19 symptoms start? (please enter an approximate date. We know not everyone will be able to tell us the exact day their symptoms started)

If you have had COVID-19 infection, did you seek medical support from any of the following?

If you have had COVID-19 infection, did you seek medical support from any of the following?

Have you ever been diagnosed with Long COVID?

Are you currently experiencing any of the following symptoms of Long COVID? (tick any that apply to you)

If you have been diagnosed with Long COVID, or think you may have Long COVID, have you tried to get support from any of the following? Please tick as many as apply.

If you are experiencing Long COVID symptoms, are they impacting on your daily life? (please tick any of the following that apply to you).