Get involved

Online Survey - Meningitis and You

 

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About You:
Title*
First Name*
Surname*
Address line 1*
Address line 2
Address line 3
Town*
County*
Postcode*
Country*
Home Telephone
Email address*
Are you happy to be contacted via email? Yes No
Please note: * means information required to submit the form

Q1. Are you:
Male Female
Q2. What is your date of birth?
- -
Q3. What is your first written language?
English
Other (please specify)
Your experience of meningitis:
If you have experienced meningitis, please answer the following questions –
if you have not please go to Q7.
Q4. Have you had meningitis?
Yes No
If yes, what type and when:
Q5. Has someone you know had meningitis?
Yes No
If yes, when:
If yes, what is their relationship to you:
Family
Friend
School
Colleague
Community
Q6. What after-effects do you/they experience?

None
What you know about meningitis:
Q7. Anyone can get meningitis at anytime.
Were you aware of this?
Yes No
Q8. Most people survive meningitis but many are left with life-changing
after-effects.
Which after-effects are you aware of that can be caused by meningitis?
Hearing Sight Loss of limbs Brain damage
Epilepsy Learning difficulties Behavioural difficulties
Memory problems Scarring Depression None
Other (please specify)
About the Meningitis Trust:
Q9. The Meningitis Trust is the UK’s longest established meningitis charity – had you heard of us before reading this questionnaire?
Yes No
Q10. The Meningitis Trust provides a range of professional support services, awareness and information materials. Which of these do you know about?
24-hour nurse-staffed helpline Financial Grants Home visits
One-to-one contacts Family days Counselling
Website Children’s website Health professional website
Symptoms cards Peer Educator scheme None


We promise not to release your information to anyone else. Your details will be used by the Meningitis Trust Charity and Meningitis Trust Trading only. We may like to contact you in the future about the Meningitis Trust’s activities, including news and information on how your money is spent. If you would rather not receive these communications please let us know.

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The Meningitis Trust

Helpline: 0800 028 18 28
Head Office: 01453 768000
Fern House, Bath Road,
Stroud, GL5 3TJ


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Registered charity number: 803016 (England and Wales), SC037790 (Scotland). Company Limited by Guarantee Registered In England & Wales Number 2469130