Long COVID Service Self-Referral

If you have any of the following symptoms, please ensure you have seen your GP before referring yourself to the Long COVID Service

To refer yourself, it is important that you complete ALL sections of the form clearly.  All information you provide will remain confidential and stored securely in line with Data Protection legislation and the organisation’s Information Governance policies and procedures. By completing this referral you consent for the Health Board to share necessary and relevant information with your GP or other appropriate healthcare professionals.

You can now refer yourself directly to the BCUHB Long COVID Service. Alternatively, you can request to be referred by your GP or health professional.

Symptoms of Long COVID include but are not limited to:

• Fatigue
• Breathlessness
• Problems with memory and concentration (brain fog)
• Mood changes (anxiety or depression)
• Chest Pain
• Heart Palpitations
• Dizziness
• Pain
• High Temperature