Cold/Flu online survey

Have you suffered from a cold or a bout of the flu recently? If you have, then please spare a few moments to take part in our short survey.

Any information gathered here is for the purposes of this survey only and will not be passed on to any third parties.

Questionnaire

1. Are you male or female? *

Male

Female

2. Do you have a lung condition? *

Yes

3. Have you had the flu or a cold this year? *

Yes

4. If yes, has your cold/flu led you to have a chest infection or breathing difficulties?

Yes

5. Did this result in your taking time off work?

Yes

I am not currently working

6. If yes, how much time did you have off work?

1 day

2 – 3 days

4 – 5 days

More than a week

7. Did you visit your GP for advice?

Yes

8. If yes, did your GP prescribe antibiotics?

Yes

Name, address and email (please note that these fields are optional)

First name

Surname

Address

Email address