Are you aged 18-55? * Yes No Do you live in North-West, West or South-West London area? * Yes No Are you registered with a GP Practice in the UK? * Yes No Are you able to travel to appointments without relying on public transport or taxis (e.g. either by driving yourself or driven by someone in your household)? * Yes No Are you currently living with anyone over 70 years old or anyone who has been identified as at high risk for severe COVID-19 disease? * Yes No Are you currently taking any medication? * Yes No Please give details of any medication you are currently taking * Are you currently under the care of, or waiting for an appointment with, a hospital specialist? * Yes No Please give details of any specialist care or appointments * Have you been diagnosed with COVID-19? * Yes No Did you have fever, persistent cough or shortness of breath in the past 30 days? * Yes No Do you have any chronic (long term) heart problems? * Yes No Do you have epilepsy? * Yes No Do you have any chronic (long-term) respiratory disease e.g. asthma? * Yes No Do you have chronic (long term) liver disease? * Yes No Do you have chronic (long-term) kidney disease? * Yes No Do you have any long-term neurological conditions? * Yes No Do you have diabetes? * Yes No Are you seriously overweight (BMI≥40 Kg/m2)? * Yes No Do you have any problems with your immune system (including problems with your spleen)? * Yes No Are you taking any immunosuppressant medication? * Yes No Are you under the care of a psychiatrist? * Yes No 16. Any other health conditions * Yes No Please give details * Have you previously taken part in a clinical trial involving a vaccine? * Yes No Please give details of any trials you have previously participated in that have involved a vaccine (if possible: the disease studied, vaccine given, who the study was with) * Have you received any vaccinations in the past 30 days or do you have any planned vaccinations coming up? * Yes No Are you currently pregnant, breastfeeding or planning on becoming pregnant over the next 6 months? * Yes No Do you have any plans to travel in the next 6 months? * Yes No Please give details of where you are planning to travel to and dates * How did you hear about us? * - Select -FacebookInstagramTwitterWord of mouthPosterEmail CircularOnline SearchDaily InfoOther If other, please specify * Thank you for your interest in our study. Based on your responses, you are eligible to proceed to screening. Please complete the below questions and we will be in touch with more information about the study and to arrange a screening appointment. Thank you for your interest in our study. Based on your responses, you might be eligible to proceed to screening. Please complete the below questions and we will be in touch if you are eligible or if we have any more questions. Thank you for your interest in our study; Based on your responses, you are not eligible to take part. What is you first name? * What is your last name? * What is your date of birth? * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006 What is your email address? * What is the first part of your postcode (e.g. NW4)? * What is your phone number * What are your GP Practice details? * 1 Start 2 Complete Math question * 16 + 0 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
