Long Covid Support Group - Expression of Interest

Your Details

Question Title

* 1. What is your age?

under 25

25-34

35-44

45-54

55-64

65-74

75-84

85 or over

Question Title

* 2. Which one best describes your ethnic group or background?

Asian or Asian British

Black, African, Black British or Caribbean

Mixed or multiple ethnic groups

White

Prefer not to say

Question Title

* 3. What is your gender?

Female

Male

Prefer not to say

Question Title

* 4. If you would like to be invited to register for our Long Covid Support Group, please leave your name, email address and phone number.

We will only get in touch with you about the Long Covid Support Group.

For more information see our Privacy policy.

Name

Email address

Phone number

Question Title

* 5. What time of day would suit you best?

Morning

Afternoon

Evening

Thank you for taking part in our survey

100% of survey complete.