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In order to gather ongoing data about the rates of smell disorders, it would be helpful if you could provide us with a snapshot of your current experience. The data collected can be anonymous - if you choose to share your email address with us then this will be kept secure and we are only collecting these details to help keep you informed about the work we do.  Your details will not be shared outside of Fifth Sense. Your responses may help with further research and demonstrate how many people are experiencing changes to their ability to smell. Thank you for taking the time to tell us about yours. 

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* 1. Please enter the date you completed this survey:

Date

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* 2. There are gender differences in how people area affected by smell disorders, please can you confirm your gender:

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* 3. Age can also be a factor in smell disorders, please confirm your age:

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* 4. Where do you live?

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* 5. Do you already have a smell disorder before you took this test?

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* 6. On picking something up that you have on hand to smell (e.g your cup of coffee/a piece of fruit/a bottle of shampoo/the fragrance you are wearing etc.) can you smell it?

Click here if you would like to join the Fifth Sense community and be kept informed about the work we do for people affected by smell and taste disorders via email.
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