Submit your details

Your information will be stored securely and will not be used for any other purpose than the dashboard display on this site, unless you consent otherwise upon submission. Please see the link to our privacy policy at the bottom of this page for further information. 

This form is intended to be filled out by people who have had and recovered from COVID-19. Thank you for taking the time to fill it out. It's hoped that this information will help others, and will help to highlight COVID-19 experiences outside health system observations and statistics.

 

Please only fill out your details once. 

Occupational sector:

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Age group:

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Sex:

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Ethnic group:

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This site focuses on these broadly-defined groups as they align with many research classifiers, due to the high proportion of the global population that fit into these categories.  

Location (Town/City + Country):

Were you tested for COVID-19 or did you suspect you had it?

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How many other people do you live with?

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How many of them have also contracted COVID-19?

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When did your first symptoms appear?

How long did you feel you had  the virus for?

1 days

When did you feel the worst?

Day 1

When do you think you started to recover?

Day 1

What symptoms did you experience?

Were you hospitalised?

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Did you require oxygen?

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Were you on a ventilator?

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How severe would you say your case was?

Asymptomatic: you felt fine and didn't experience noticeable symptoms

Mild: you felt unwell, but no worse than when you've had a heavy cold or flu

Moderate: you felt very unwell and needed regular medication and a lot of rest to manage your symptoms

Severe: you were extremely unwell and needed hospitalisation

Critical: you were critically ill and needed medical intervention to assist your breathing

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What one word would you choose that most describes how you felt, physically?

Felt physically error

What one word would you choose that most describes how you felt, mentally?

Felt mentally error

What's your email address?

If you are submitting on behalf of someone under 18:

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Your details have  been submitted, thank you

You can also submit your story for publication on this site, here