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SMEFG Long Covid Questionnaire
We want to learn more about how Long Covid is affecting people's lives, and what support you would benefit from that we could provide.
Take your time to go through the questionnaire at your own pace. Additional space is provided to expand.
If you would like to tell us your story by phone conversation, please call us at: 07753948186
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* Indicates required question
How long have you been unwell with long covid?
less than 3 months
between 3 and 6 months
more than 6 months
Clear selection
Please say the 3 ways long covid is affecting your life the most - it could be financially, socially, work, relationships, physical activity, feeling low as well as physical symptoms.
Your answer
Are you currently living with Fibromyalgia / ME / CFS or any other long-term health conditions?
ME/CFS
Fibromyalgia
Other:
What kind of support would help you the most?
Benefits advice
Helpful aids / adaptations
Social care advocacy
Sharing information about long covid
Nutrition and cookery
Mindfulness
Qigong (breathing, meditation)
Seated tai chi
Singing
Arts and Craft
Social drop ins
Quizzes
Facebook support
Befriending
Other:
Please give your contact details if you would like us to get back in touch with you (email or phone number).
Your answer
Would you like to share here your story in a short paragraph, that we could share on our website to raise awareness about living with long covid? If you prefer to tell us over the phone, you can call us on 07753948186.
Your answer
Would you be happy for us to share your story anonymously / on the website? Tick yes to agree to give your consent. Alternatively, please fill in the 'other' field with a name you wish to use.
Yes, anonymously
No
Other:
Clear selection
Do you live in South Yorkshire or North Derbyshire?
*
Yes
No
How old are you?
Under 21
22-40
40-50
60-70
over 70
Clear selection
Are you
Male
Female
Prefer not to say
Other:
Clear selection
What is your ethnic group?
White
Black, African or Caribbean
Asian
Arab
Mixed or multiple ethnic groups
Other:
Clear selection
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