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Self-Screening Questionnaire

This page is for your self-screening questionnaire if you need one.
You can provide your own questions and specify which answers would be ‘eligible’.
There are a variety other response types available.

None of the information from this form is stored anywhere, so there’s no need for privacy statements or any other GDPR measures.

The answers are Yes, No, Yes, No for an eligible result. Any other combination will give an ineligible result.

Eligible results will take you to a contact page, ineligible results will open an ineligible page/

Are you interested in taking part in EXAMPLE1?

Are you being treated for your illness?

Are you on any medication?

Do you have any co-morbidities?