Please tell us about your experience. (For example, what went well and what could have been better?)
If you'd rather be anonymous, avoid including things that can identify you.
When did this experience happen?
* Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month
Year 2020 2021 Year
If you are telling us about more than one experience, please give us the date of your most recent experience. If you are telling us about a long delay for treatment - please put today's date.
Please tell us which county or city you live in?
* Please tell us a little bit about yourself
By telling us more information about yourself, you can help us better understand how people's experiences may differ depending on their personal characteristics. You don't need to answer these questions if you don't want to.
How old are you?
- 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
How would you describe your gender?
- None - Woman / girl Man / boy Non-binary Intersex Prefer to self-describe Prefer not to say Is your gender the same as the sex recorded at birth?
How would you describe your sexuality
- None - Asexual Bisexual Gay man Heterosexual or straight Lesbian / Gay woman Pansexual Prefer to self describe Prefer not to say
How would you describe your ethnicity?
- None - Arab Asian or Asian British: Bangladeshi Asian / Asian British: Chinese Asian / Asian British: Indian Asian or Asian British: Pakistani Asian / Asian British: Any other Asian / Asian British background Black / Black British: African Black / Black British: Caribbean Black / Black British: Any other Black / Black British background 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 White: British / English / Northern Irish / Scottish / Welsh White: Irish White: Gypsy, Traveller or Irish Traveller White: Roma White: Any other White background Any other ethnic group Prefer not to say
What is your religion?
- None - Buddhist Christian Hindu Jewish Muslim No religion Sikh Other religion Prefer not to say
What is your marital or civil partnership status?
- None - Single Cohabiting In a civil partnership Married Separated Divorced / Dissolved civil partnership Widowed Prefer not to say What is your pregnancy or maternity status?
You can select more than one option if you need to.
Do you have a disability?
If yes, please tell us what your disability is
Do you have a long-term condition?
If yes, please tell us what long-term condition you have
How did you hear about us?
Which of the following best describes your current financial status?