We encourage you to complete and submit the following questionnaire ahead of your PFAS Testing and Intervention Service appointment. While this is not mandatory, your responses will help the doctor understand more about your exposure history, allowing for a more informed and meaningful conversation during your appointment.
The purpose of the information gathered here is to understand potential PFAS exposure. Factors such as drinking water sources, dietary choices and occupation can have an impact on PFAS exposure, therefore you will be asked to answer some questions about your lifestyle. It will also be helpful to have an understanding of the levels of PFAS in your blood, details of any support you have received to date and the areas of your individual health that you are most concerned about.
Before completing the questionnaire
You will be asked to provide details of previous addresses that you have lived at and the previous occupations you have had, since 1980. It would be useful if you could gather as much of this information as you can before starting the questionnaire.
This questionnaire should take you around 15 minutes to complete.
Please submit the questionnaire ahead of your appointment so that the doctor can discuss your answers during your appointment.
Your data
The data you supply when submitting this questionnaire will be used for the purpose of supporting your care. The information is retained in line with Data Protection (Jersey) Law 2018 and Health and Care Jersey (HCJ) information governance policies and procedures. The data is secure at all times and accessible only to those who have a 'need to know' when providing care and treatment. Data will also be anonymised and used for monitoring and evaluating the service we are delivering. For more information about how HCJ process your personal data, please visit the Health and Care Jersey privacy policy.
Have any queries or require assistance?
If you have any questions or need assistance completing the survey, please contact HCJ on PFASadmin@health.gov.je or (01534) 444461.