We will only use this to call you if there is any problem with your email address, or to send a text reminder if you book a screening appointment.

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

6.6. Are you registered with a GP Practice in the UK? Required
7.7. Are you currently taking any medication? Required
8.8. Are you currently under the care of, or waiting forĀ an appointment with, a hospital specialist? Required
9.9. Have you previously taken part in a clinical trial involving a vaccine? Required
10.10. Have you been diagnosed with any inflammatory bowel diseases (e.g. Crohn's disease, Ulcerative colitis)? Required
11.11. How did you hear about us? Required

If you submit your answers you will not be able to return to this page.