Enhanced Access Services Patient Survey

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1. About You...
Page 1 of 4

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Age

Under 18
18-24
25-34
35-44
45-54
55-64
65 or Above
Prefer not to answer

Gender

Male
Female
Non-binary
Prefer not to answer
Other -

Ethnic Group

Asian or Asian British
Black, Black British, Caribbean or African
Gypsy, Traveller or Roma Community
Mixed or Multiple ethnic groups
White
Other ethnic group -

Employment Status

Employed Full-Time
Employed Part-Time
Self-employed
Not employed but looking for work
Not employed and not looking for work
homemaker
Retired
Military
Carer
Unable to work
Prefer not to answer
Other (please specify):

Preferred method of travel

Car
Bus
taxi
Cycle
On-foot
Prefer not to answer
Other (please specify):

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