Introduction

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. 

You can find out more about how we use your information on this website: www.healthwatch.co.uk/privacy

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... 

 

About you

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? 

Gender is whether you like to be known as male, female or something else.

 

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.

  • Asian or Asian British
  • Black or Black British
  • Mixed or more than one ethnicity
  • White
  • Other
 

12. Are any of these true for you? 

 

13. How much money do you have?

 

14. What area do you live in?

 

Can we contact you? 

15. Using your story

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. 

 

16. Getting emails from us

Would you like us to email you with information about what we are doing? 

You can stop getting emails from us at any time.

 

17. If you ticked yes, please write your name and email address below.