1. Choose the area of care you would like to tell us about?
(for adults, children or young people)
Please select the options that you'd like to talk to us about. You can pick more than one.
If other, please tell us which issue/service you are referring to
What went well? What could have been better?
eg. the GP surgery name or hospital department
4. How easy was it to access the help and support you needed?
5. How would you describe your experience of care?
6. In relation to this experience please select what best describes you
If you are sharing information on behalf of another person, make sure that you have their permission to do so, or the information you do share should be anonymous.)
Title

It would really help to know a little more about you so that we can better understand how people's experiences may differ. These questions are completely voluntary.

This helps us to help us understand how different groups experience local health and social care services and supports our focus on improving equality, diversity and inclusion. It also helps us identify trends and gaps in our information gathering, enabling us to be more inclusive.

8. Please tell us your gender
10. Please tell us which sexual orientation you identify with
11. Please select your ethnicity
12. Please select any of the following that apply to you
Please select
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