Long COVID-19 enquiry

Please note: We can only deal with Long COVID cases for healthcare workers in England and Wales.

Your Details
First name*
Surname*
Email*
Contact number
Postcode*
Employer*
Job title and department*
Date of exposure*
MM slash DD slash YYYY
Date of first symptoms*
MM slash DD slash YYYY
Date of positive test (if you received one) or date of diagnosis*
MM slash DD slash YYYY
Location of exposure (Hospital ward, community etc)*

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