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Campylobacter disease investigation questionnaire
The information in this questionnaire will be treated as STRICTLY CONFIDENTIAL We take your privacy very seriously and will ensure that your data is kept secure. For more information, please view the council's privacy notice.
Please enter your unique reference number
Maximum 12 characters
0/12
What date did you start to feel unwell?
Are you still ill?
Did you have any of the following symptoms?
With this illness, were you admitted to hospital?
Do you take any drugs or suffer from a condition that results in you being immunosuppressed?
Has anyone in your house been ill with diarrhoea recently?
Did you have contact with anyone outside your household (e.g friends) who have been ill with diarrhoea recently?
