Not in the US? Country * Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cabo Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao North Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Which month did you lose your loved one/s? * Prior to February 20 February 20 March 20 April 20 May 20 June 20 July 20 August 20 September 20 October 20 November 20 December 20 January 21 February 21 March 21 April 21 May 21 June 21 July 21 August 21 September 21 October 21 November 21 December 21 January 22 February 22 March 22 April 22 May 22 June 22 July 22 August 22

Which of the following areas applies to your personal story and your lost loved one? Details about your loved one section. * NHS worker Transport worker School worker University worker Other Key worker Underlying health conditions No underlying health conditions Disabled Black and Minority Ethnic Other (Please type in the free box which is the last question) None of these

Which of the following areas applies to your personal story and your lost loved one? Your Loved ones care section. * Hospital Acquired Covid Care Homes Residential care Home care Transfer from hospital to care home and vice versa Issues with advice provided via 111/NHS 24 or 999 and ambulance service issues relating to shielding advice Issues relating to application of do not attempt resuscitation (DNAR) order Issues relating to PPE Hospital failings/Quality of Care difficulties/lack of opportunity to visit or speak to loved one in hospital/care home Other (Please type in the free box which is the last question) None of these

Which of the following areas applies to your personal story and your lost loved one? Details on government policy and wider world section. * Issues relating to lockdown including late lockdown Border Control/Lack of quarantine Track and Trace Mass gatherings Eat Out To Help Out Public health messaging/Misleading messaging such as only those over 70 at risk, only the already ill are at risk, etc concerns relating to access to/prioritisation of vaccines Other (Please type in the free box which is the last question) None of these

Which of the following areas applies to your personal story and your lost loved one? Details about you section. * Loss of multiple family members Financial challenges as a result of bereavement issues with conspiracy theorists and others minimising loss Challenges accessing bereavement support I've helped volunteer on the vaccine programme Other (Please type in the free box which is the last question)

In which setting did your loved one/s pass away? * At home In a care home In a hospital Other (Please type in the free box which is the last question)

What age was your loved one/s when they passed? *

If you feel comfortable please explain a little more of your and your loves ones stories. If you would rather speak over the phone then please leave your email address in this box and we will be in touch to arrange a time to speak over the phone.

Please let us know of anything else you want us to know around yours and your loved ones personal stories