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Corona Virus Survey
*
Indicates required field
Name
*
First
Last
Email
*
Do you consent to RAMFEL contacting you by email?
*
Yes
No
What is your preferred spoken language?
*
How well can you understand English? (Select all that apply)
*
I can read English
I can write in English
I can speak English
Address Line 1
*
Address Line 2
*
City
*
Post Code
*
Preferred Reading Language
*
What support / Income do you recieve? (Select all that apply)
*
Benefits
Working
Asylum Support
Social Services Support
No Income
Do you feel like you adequate information about Corona Virus? (such as when to contact 111 or rules about COVID 19 such as the need to stay at home and social distancing)?
*
Select Option
Yes
No
If not, could you describe what information you need?
*
Do you currently have any issue in getting food or medicine?
*
Select Option
Yes
No
If yes, what is your issue?
*
Do you have anything you need to leave the house for other than food, medicine or exercise?
*
Select Option
Yes
No
Are you able to check email for regular information and messages from us?
*
Select Option
Yes
No
How much support do you receive per week?
*
How many dependents / household family members do you have living with you?
*
What kind of accomadation do you live in? (I.E. shared, private, Nass)
*
If you live in shared accomadation, what facilities do you share with others? (Kitchen, Bathroom, Living Room, etc.)
*
Are you able to self isolate in your accomadation?
*
Select Option
Yes
No
Are you registered with a local GP?
*
Select Option
Yes
No
Do you have a valid HC2 certificate or in receive of benefit that exempts them from paying health cost? (Such as - Universal Credit, Income Support, income-based Jobseeker's Allowance, income-related Employment and Support Allowance or the guarantee credit part of Pension Credit).
*
Select Option
Yes
No
Do you have any existing health issues, that put you at additional risk from coronavirus?
*
Select Option
Yes
No
Coronavirus can make anyone seriously ill, but there are some people who are at a higher risk. For example, you may be at high risk from coronavirus if you: have had an organ transplant are having certain types of cancer treatment have blood or bone marrow cancer, such as leukaemia have a severe lung condition, such as cystic fibrosis or severe asthma have a condition that makes you much more likely to get infections are taking medicine that weakens your immune system are pregnant and have a serious heart condition
If yes, could you explain the issue?
*
Do you need help to convey any health issues to your GP?
*
N/A
Yes
No
In what way do you need assistance?
*
Submit
Home
About
Staff and Trustees
Take Action
Our Services
Get Involved
Information
News and Blog
Report on the Hostile Environment
Health Care Report
Policies
EUSS Translated Letters
Complaints
Contact
Donate