Indicates required field Take five minutes to share your experiences NHS and social care staff are doing everything they can to keep us well during these challenging times, but there might be things that can be improved for you and your loved ones. Please take five minutes to share your story with us. To understand how we will use your information read the 'How we use this information' at the end of the page. Complete the survey Are you happy for us to collect your information? Please read our privacy statement for details on how we store and use your data. Choose the area of care you would like to tell us about? GP services Dentist Pharmacies Hospital inpatient (day treatment or overnight) Hospital outpatient Mental health support Social care (care homes, and home care) Accident and emergency/minor injury units NHS 111 Other issue/service (if other, please tell us which issue/service you are referring to) 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 Please tell us about you experience What went well? What could have been better? Does your feedback apply to a specific service? If so, please tell us which ones(s). eg. the GP surgery name or hospital department Tell us a bit about you (Optional)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 voluntary. If you would like us to get back to you please include your email address. Email address (optional) Please tell us your age - None -Under 1818 to 24 years25 to 29 years30 to 34 years35 to 39 years40 to 44 years45 to 49 years50 to 54 years55 to 59 years60 to 64 years65 to 69 years70+ yearsPrefer not to say Please tell us your gender Please tell us your gender - None -WomanManNon-binaryPrefer not to sayPrefer to self-describe Enter other… Please tell us which sexual orientation you identify with Please tell us which sexual orientation you identify with - None -AsexualBisexualGay manHeterosexual / StraightLesbian / Gay womanPansexualPrefer not to sayPrefer to self-describe Enter other… Please select your ethnicity Please select your ethnicity - None -ArabAsian / Asian British: BangladeshiAsian / Asian British: ChineseAsian / Asian British: IndianAsian / Asian British: PakistaniAsian / Asian British: Any other Asian / Asian British backgroundBlack / Black British: AfricanBlack / Black British: CaribbeanBlack / Black British: Any other Black / Black British backgroundMixed / Multiple ethnic groups: Asian and WhiteMixed / Multiple ethnic groups: Black African and WhiteMixed / Multiple ethnic groups: Black Caribbean and WhiteMixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups backgroundWhite: British / English / Northern Irish / Scottish / WelshWhite: IrishWhite: Gypsy, Traveller or Irish TravellerWhite: RomaWhite: Any other White backgroundPrefer not to sayAny other ethnic group Enter other… Please select any of the following that apply to you I have a disability I have a long term condition I am a carer None of the above I prefer not to say Please tell us the first section of your postcode (optional) Sign-up to our mailing list Sign-up to our mailing list to stay up to date with what people are telling us about health and social care, our advice and information, and our latest reports. You can unsubscribe from our mailing list at any time. Please select the option if you wish to/ not wish to sign up to our mailing list. Please select the option if you wish to/ not wish to sign up to our mailing list. - None -No, I do not want to sign upYes, I would like to sign up (please provide email address) Enter other… How we use this informationThe information you share with us helps us spot trends to identify areas for improvement. We may use quotes in our reports, but we will not use any information that will identify you.As well as your feedback, we also ask you to volunteer some personal information. 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. 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. Submit Leave this field blank