About you
What is your postcode?
(UPPERCASE required. E.G. DN31 1HU)
What is your age?
What is your age?
Under 18
18-24
25-34
35-49
50-64
65-79
80+
I prefer not to say
Which of the following options best describes how you think of yourself?
Which of the following options best describes how you think of yourself?
Woman
Man
Non-binary
I prefer not to say
In another way
Have you gone through any part of a process to change from the sex you were described as at birth to the gender you identify with or intend to?
Have you gone through any part of a process to change from the sex you were described as at birth to the gender you identify with or intend to?
Yes
No
I prefer not to say
Which of the following options best describes how you think of yourself?
Which of the following options best describes how you think of yourself?
Straight
Lesbian
Bisexual
Gay
I prefer not to say
In another way
What is your relationship status?
What is your relationship status?
Single
Married
Civil Partnership
In a relationship (living together)
In a relationship (not living together)
Widowed
Divorced
I prefer not to say
Separated
Do you consider yourself to have a disability? Please tick the most appropriate
No disability
Physical impairment such as difficulty moving your arms or mobility issues
Wheelchair user
Sensory impairment such as being blind or having a visual impairment
Sensory impairment such as being deaf or having a hearing impairment
Mental health condition such as depression, dementia or schizophrenia
Long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsy
Learning disability or difficulty (such as Down's syndrome or dyslexia) or cognitive impairment (such as autistic spectrum disorder)
I prefer not to say
Other (please specify)
What is your religion or belief?
What is your religion or belief?
Christian
Muslim
Buddhist
Sikh
Jewish
Hindu
No religion
I prefer not to say
Other religion - please say
Which option best describes your ethnicity?
Which option best describes your ethnicity?
-- Select --
White - English, Welsh, Scottish, Northern Irish or British
White - Irish
White - Gypsy or Irish Traveller
White - Any other White background
Mixed - White and Black Caribbean
Mixed - White and Black African
Mixed - White and Asian
Mixed - Any other Mixed background
Mixed - Asian or Asian British-Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - And other Asian background
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Any other Black background
Arab
I prefer not to say
Any other ethnic group
Do you have any experiences where your interaction with our services have been positively or negatively affected because of your protected characteristics.
These are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.
Do you have any experiences where your interaction with our services have been positively or negatively affected because of your protected characteristics.These are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.
Yes
No
Not sure
If you're able to do so, please share details of your experience
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