Long Covid Clinics - share your experience
We are interested to hear your experiences of the NHS England Long Covid clinics (also referred to as Assessment Centres) announced on December 18th, 2020 https://www.england.nhs.uk/2020/12/long-covid-patients-to-get-help-at-more-than-60-clinics/ 

If you have asked and/or been referred to a Long Covid clinic more than once, please tell us about your MOST RECENT experience.

This survey has been designed by the Long Covid Support Group to collate information on the patient experience of accessing and use of Long Covid clinics in England.  
Data collected will be anonymised and analysed to produce a report to inform medical professionals, health organisations and interested stakeholder groups such as NHSE, Royal Colleges and research bodies. This survey will remain open to allow the continous evaluation of the patient experience.
Sign in to Google to save your progress. Learn more
1. Do you have confirmation of having been infected with Covid-19? *
Required
2. Were you admitted to hospital within 4 weeks of initial infection/symptoms? (Other than A&E or outpatient visits) *
Required
3. Did you ask for a referral to a Long Covid clinic before or after the announcement of services in England on 18th December 2020? If you have asked more than once to be referred, please answer about your most recent experience
Clear selection
4. Have you been referred to a Long Covid clinic? Answer yes even if you have been referred but have not yet had your first appointment at the clinic. If no, jump to Question 11 after this question *
Required
5. Who referred you to the Long Covid clinic?
6. Which Long Covid clinic did you attend?
7. When was your most recent appointment at a Long Covid clinic?
Put an approximate date if you don't remember exactly.
MM
/
DD
/
YYYY
8. Which type(s) of medical professional assessed you at the Long Covid clinic?
Select all that apply.
9. What was the outcome of your appointment?
Select all that apply.
10. How satisfied are you with your experience of the Long Covid clinic?  
Unsatisfied
Neutral
Satisfied
Very satisfied
Not applicable
Overall
Time from referral to first appointment
Opportunity to be listened to
Access to appropriate specialists
Length of appointment
Practical support to aid recovery
Clarity of next steps / follow-up services
Nature of next steps / follow-up services
Clear selection
11. Do you have any comments you wish to add?
Please do not include any personal information that could identify you or others
12. Have you been referred to any other post Covid care providers? Answer even if you have not attended a Long Covid clinic or Assessment Centre *
13. If yes, please provide details.
14. If you are able to, please select your Clinical Commissioning Group (CCG) for the area you live in. If you do not know, please enter the first part of your postcode in the next question
15. Please provide the first part of your postcode.
For example, PO1
16. How do you identify?
Clear selection
17. How would you describe your ethnicity?
Clear selection
18. Did you have any long-term conditions or disabilities before you fell ill with Covid? *
19. Do you give permission for your words to be quoted anonymously in the report? *
Data compiled will be anonymised and analysed to produce a report to inform medical professionals, research organisations and interested stakeholder groups such as NHSE, Royal Colleges and research bodies.
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy