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- If 'someone else' Please let us know the relationship you have with that person
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- Do you have any health conditions or illness lasting or expected to last 12 months or more? This includes MCAS or any other health condition*
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- Do any of your conditions or illnesses reduce your ability to carry out day to day activities? For example eating, washing, walking or going shopping*
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- Does having a health condition or caring for someone with a health condition put your household under financial strain?
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- Have you contacted your local MP?*
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- Under what type of medical care were you diagnosed?
- Month and year of diagnosis? (don't worry about the specific day)
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- How long did it take to receive a diagnosis?
- Are you receiving appropriate care for your condition?*
- Approximately how many healthcare specialists have you seen?*
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- Primary symptoms (select all that apply)*
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- Are you happy to be contacted about your story? (e.g media, MP engagement)*
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- Should be Empty: