To understand how we will use your information read the 'How we use this information' at the end of the page.
This survey is also available in Easy Read.
It would really help to know a little more about the person who this experience relates to so that we can better understand how people's experiences may differ. These questions are completely voluntary.
The 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.
Find out more about how we handle your information in our privacy statement.
To promote our campaigns we use people's stories to show what needs to change. The media (newspapers, radio or TV) ask if we have people who can share their story when we publish a press release about our research.
Would you be happy for us to contact you about your experience for media purposes or to use your story as a case study in our communications materials? We won’t pass on your name and contact details to the media without your consent and speaking to you first about what it involves.
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If yes, enter your name and email address.