Lockdown diaries submission form
Name
*
First Name
Last Name
Age
*
Location
Occupation
Email (not for publication)
*
example@example.com
Do you consent to your name, age, location, and occupation being published on wellbeanblog and associated social media plaforms?
*
Please Select
Yes
No
Name only
Age only
Occupation only
Name and age only
Name and location only
Name and occupation only
Age and location only
Age and occupation only
How have you coped during the COVID 19 pandemic?
*
Has your mental health been affected as a result of the pandemic?
*
Have your circumstances changed due to the pandemic? E.g. Job loss etc.
*
What do you think you have you learnt during the pandemic about yourself and others?
*
Will your lifestyle change as a result of the pandemic?
*
Summarise your lockdown in three words
*
Upload a photo of yourself only. No children unless they are your own and you consent to them being published on wellbeanblog and wellbean's social platforms.
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