Easy Read - Have your say

We are Healthwatch.
We work to make sure health and care services are the best they can be for the people who use them.

We want to know if you think there are things that health and care services can do to improve.
Please answer these questions to tell us.

How we use your information

We will use the information you give us to spot things that could be better.
We might use the things you say in reports, but we will not use your name.
If you are giving us information for someone else, make sure you have asked them first

1. What kind of service would you like to tell us about? You can pick more than one.
*

Other issue or survey - please tell us which service you are talking about:

2. Please tell us what happened to you:

Think about:
What went well?
What could have been better? *

3. Are you talking about a particular service, like a part of a hospital or your local doctor?

If so, please tell us which one:

4. How easy was it to get the help and support you needed?
*

5. How good would you say your care was?
*

6. Are you: *

The person who got the care
A friend, family member or carer of the person who got the care
Someone else

It would be helpful to know more about you.

This helps us see if different people get better or worse care.

You do not have to answer these questions.

7. How old are you?
*

8. What is your gender?
*

Comment:

9. Is your gender the same as the one you were given when you were born?
*

Yes
No
Prefer not to say

10. What is your sexual orientation?
Sexual orientation means which gender you are attracted to. For example, male, female or both.
*

Asexual - this means you are not attracted to anybody.
Bisexual - this means you are attracted to men and women
Gay man - this means you are a man who is attracted to other men
Heterosexual or straight - this means you are attracted to the opposite gender
Lesbian or gay woman - this means you are a woman who is attracted to other women
Pansexual - this means you are attracted to people no matter their gender
Prefer not to say
I prefer to use my own words (please write this in the box below):

Comment:

11. What is your ethnicity?
Ethnicity is your race or background. For example, Black, White or Asian.
*

12. Are any of these true for you? *

13. How much money do you have? *

I have plenty to spend on things I need, and plenty left for extras I want
I have enough to spend on things I need, and a small amount for extras I want
I have enough to spend on things I need, and not much else
I don't have enough for things I need, and sometimes run out of money
I don't know
Prefer not to say

14. Can we contact you?
We use the stories people tell us when we talk about our work to the media. The media is newspapers, radio or TV.

Can we contact you if we want to talk about your story to the media?

We will not give them your name without asking you first.

*

Yes
No
If you ticked yes, please write your name and email address below:

Comment:

Easy Read - Have your say

1. What kind of service would you like to tell us about? You can pick more than one. *

2. Please tell us what happened to you:Think about: What went well? What could have been better? *

3. Are you talking about a particular service, like a part of a hospital or your local doctor?If so, please tell us which one:

4. How easy was it to get the help and support you needed? *

5. How good would you say your care was? *

6. Are you: *

7. How old are you? *

8. What is your gender? *

9. Is your gender the same as the one you were given when you were born? *

10. What is your sexual orientation?Sexual orientation means which gender you are attracted to. For example, male, female or both. *

11. What is your ethnicity?Ethnicity is your race or background. For example, Black, White or Asian. *

12. Are any of these true for you? *

13. How much money do you have? *

14. Can we contact you?We use the stories people tell us when we talk about our work to the media. The media is newspapers, radio or TV. Can we contact you if we want to talk about your story to the media? We will not give them your name without asking you first. *

1. What kind of service would you like to tell us about? You can pick more than one.
*

2. Please tell us what happened to you:

Think about:
What went well?
What could have been better? *

3. Are you talking about a particular service, like a part of a hospital or your local doctor?

If so, please tell us which one:

4. How easy was it to get the help and support you needed?
*

5. How good would you say your care was?
*

7. How old are you?
*

8. What is your gender?
*

9. Is your gender the same as the one you were given when you were born?
*

10. What is your sexual orientation?
Sexual orientation means which gender you are attracted to. For example, male, female or both.
*

11. What is your ethnicity?
Ethnicity is your race or background. For example, Black, White or Asian.
*

14. Can we contact you?
We use the stories people tell us when we talk about our work to the media. The media is newspapers, radio or TV.

Can we contact you if we want to talk about your story to the media?

We will not give them your name without asking you first.

*