Welcome to Research for the Future.

By registering to hear about research, you are helping the NHS continue to discover better ways to prevent, diagnose and manage illness.

If you have any problems completing this form please contact us or telephone 0161 206 3636.

Fields marked with * are mandatory

Gender

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If you are having problems registering your postcode please contact us or telephone 0161 206 3636

Communication needs
Communication support required

Your health

This can be found on your prescription or a letter from the NHS

Examples of a test are: PCR swab, or lateral flow

Have you ever tested positive for Covid-19?
Was your test more that 12 weeks ago?
Have you fully recovered?
Have you received at least one dose of a vaccine for Covid-19?
I have

Please complete the diabetes section below

Please complete the respiratory disease section below
Type of respiratory disease

Includes chronic bronchitis and emphysema

Do you currently smoke tobacco?
Do you currently vape or use e-cigarettes?
Do you have allergies?
Type of allergies

Includes hayfever, rhinitis, pets, house dust mite, moulds

Includes cosmetics, eczema, nickel, dye, sun, urticarial

Includes any food, milk, egg, nut, wheat


Please complete the heart disease section below
Type of heart disease
I have also had

Includes bypass, graft, valve replacement

I take medication for high blood pressure
I take medication for high cholesterol
I have a parent or sibling with heart disease

Please complete the kidney disease section below
What type of kidney problem do you have now?
  • Reduced kidney function over time. Categorised according to kidney function (eGFR) and amount of protein in urine

  • Sudden loss of kidney function and damage

What is the cause of your kidney problem?

Kidney inflammation due to infection or autoimmune condition



I confirm

If you have any problems completing this form please contact us or telephone 0161 206 3636.

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