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Giardia 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 255 characters
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Occupation
Ethnic origin
On which date did your symptoms start?
Are you still ill?
How many days were you ill for?
For how many days were you prevented from going to work or from undertaking your normal daily activities because of your illness?
Did you visit a doctor for this illness?
Were you admitted to hospital?
