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* 1. What physical, neurological and psychological symptoms are you experiencing which you believe to be Long COVID?

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* 2. Has your COVID diagnosis or your experience of Long COVID had any other negative impacts on your life?

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* 3. What support, if any, have you accessed? eg. Occupational Health, Health Professionals, Community and Voluntary Organisations, Online support, Support of family/friends etc.

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* 4. What supports would you find helpful? eg 1:1 advice, group support, online information, webinars from health professionals etc

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* 5. Would you like to be involved in helping us set up support for people impacted by Long COVID?

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* 6. Please use this space for any other comments

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