First Name

Last Name

Email *

What was the opening search term used on the Symptom Checker? *

Summary of Symptom Checker issue * In order to investigate any issue we need to know when you were using the Symptom Checker and what age of user you gave. We only use this information to identify the Symptom Checker workflow, NOT to identify you as an individual.

Date of Symptom Checker use (dd/mm/yyyy) *

Time of Symptom Checker use (GMT) *

Place of Symptom Checker use (country only) *

What age (years) did you type for the user? *

Select one option: * I am not a healthcare professionalI am a healthcare professional

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