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MHW 26
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My experience of Covid-19

Please tell us as much as you can - we want to know all about men's experience of Covid-19. Thanks very much.

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Name

Age *

When did you have Covid-19? *

eg. early April - about 3 months ago.

Was your Covid-19… *

Mild = little or no impact on your life; Moderate = some inconvenience (eg could not work); Serious = you needed hospital treatment.

Mild

Moderate

Serious

Describe the experience of Covid-19 for you. *

Write as much as you like - the box expands

Did you have a test? *

Yes, tested positive

Yes, tested negative

No test

If, no, why not. If yes, how was it? *

If yes, what sort of test was it, was it easy or difficult, quick or slow etc.

Do you have any underlying physical or mental health conditions that might have affected your experience?

Do you think any other factors may have affected your experience?

We're thinking about things like ethnicity, geographical location, community, income, class, disability, sexual identity or gender identity - all of which have been suggested as factors in experience of Covid-19. You might have something else you want to mention.

How do you feel now? *

Are you fully recovered or not? Have you had any unexpected symptoms or difficulty getting over any symptoms?

How has it all affected your mental wellbeing? *

What is your attitude now? *

In terms of going out etc, what risks are you taking and how do you feel about them?

Your message to other men about Covid-19

Anything else you'd like to share?

If you're happy to be contacted again, add a mobile number or email here.

Leave this field blank

Event

Event Name *

Event Description

Event Date: *

Year

Day

Month

Event Time: *

Hour

Minute

Event Web Link *

Event Address (if any)

Want us to list or publicise it? *

Yes

Organiser

Name of Organisation

Phone number

Leave this field blank

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