Self-assessment Survey 1

Tackling Covid-linked Health Inequalities in North Central London

Long COVID and Digital Inclusion Project

Name and Surname*
MM slash DD slash YYYY
Programmes Needed*

On a scale of 1 to 10, where 1 is None and 10 is Tremendously, how would you rate your current status in terms of?

1) Having friends*
2) Feeling social*
3) Feeling lonely*
4) Feeling stressed*
5) Being physically active*
6) Being independent*
7) Using computer and internet confidently*
8) Having access to online resources easily*
9. English language skills*
10) Your children’s success level in their school subjects (if applicable)*
11) Your children’s social life*
12) Your children’s level of stress*
Terms and Conditions*