Take five minutes to share your experiences
NHS and social care staff are doing everything thy can during these challenging times, but there might be things that can be improved. Your feedback can help services spot issues that are affecting care for you and your loved ones.
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Your feedback *
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If yes, please tell us the name of this service.
Please tell us which gender you identify with
- None - Man Woman Non-binary Prefer to self describe Prefer not to say
Please describe your gender
Is your gender different to the sex you were assigned at birth?
- None - Yes No Prefer not to say Not known
Please tell us which sexual orientation you identify with
- None - Asexual Bisexual Gay man Heterosexual / Straight Lesbian / Gay woman Pansexual Prefer to self-describe Prefer not to say Not known
Please describe your sexual orientation
Please tell us which age category you fall into
- None - 0 to 12 years 13 to 15 years 16 to 17 years 18 to 24 years 25 to 49 years 50 to 64 years 65 to 79 years 80+ years Prefer not to say Not known
Please select your ethnicity from the list below
- None - Arab Asian / Asian British: Bangladeshi Asian / Asian British: Chinese Asian / Asian British: Indian Asian / Asian British: Pakistani Asian / Asian British: Any other Asian / Asian British background (please specify) Black / Black British: African (please specify) Black / Black British: Caribbean Black / Black British: Any other Black / Black British background (please specify) Mixed / Multiple ethnic groups: Asian and White Mixed / Multiple ethnic groups: Black African and White Mixed / Multiple ethnic groups: Black Caribbean and White Mixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups background (please specify) White: British / English / Northern Irish / Scottish / Welsh White: Irish White: Gypsy, Traveller or Irish Traveller White: Roma White: Any other White background (please specify) Any other ethnic group (please specify) Prefer not to say Not known
Please describe your ethnicity
