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Coventry Questionnaire

Consent

 
About you
 

 
About your education
 

 
About your health
 

 
About health information and advice
 

 
The next question asks about how you access health information and advice
 
Please tick all which apply to you

 
About Online Health Information and Advice
 

 
The next few questions ask about your use of online health information and advice.
 
Please tick all that apply
In my opinion online health information and advice

 
Your views about the proposed online self-assessment system.
 

 
This online system (available via the Student Health Centre website) would allow patients to anonymously self assess their need to seek care through responding to questions that are generated in response to the symptoms that you are experiencing.
 
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Thank you so much for taking time to complete this questionnaire. If you wish to change your answers, please do so before submitting your questionnaire. By submitting your questionnaire you are consenting to take part in this research project. Once again, thank-you for sparing your time to complete and submit this questionnaire.
 
Privacy statement
This form is anonymous. No data which personally identifies you is collected on the form, and the data you provide is used solely for research purposes.
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