Take five minutes to share your experiences NHS and social care staff are doing everything they can to keep us well during these challenging times, but there might be things that can be improved. Your feedback can help services spot issues that are affecting care for you and your loved ones. Complete the survey 1. Choose the area of care you would like to tell us about? GP services Dentist Pharmacies Hospital inpatient (day treatment or overnight) Hospital outpatients' appointments Mental health support Social care eg care homes, and home care Accident and emergency/minor injury units Ambulances and paramedics NHS 111 Other issue/service (if other, please tell us which issue/service you are referring to) Please select the options that you'd like to talk to us about. You can pick more than one. If other, please tell us which issue/service you are referring to 2. Please tell us about you experience What went well? What could have been better? 3. Does your feedback apply to a specific service? If so, please tell us which ones(s). eg. the GP surgery name or hospital department 4. How easy was it to access the help and support you needed? Very good Good Neither good nor bad Poor Very poor N/A 5. How would you describe your experience of care? Good Neither good nor bad Poor I had a mixed experience Don't know/not sure Not applicable 6. In relation to this experience please select what best describes you I’m the person who received the care I’m providing this feedback on behalf of a friend or relative, or because I’m their carer Other Tell us a bit about you By telling us more information about yourself, you will help us better understand how people's experiences may differ depending on their personal characteristics. However, if you do not wish to answer these questions you do not have to. 7. Please tell us your age - None -16 to 17 years18 to 24 years25 to 49 years50 to 64 years65 to 79 yearsAllNot known 8. Please tell us your gender - None -WomenMenNon-binary peopleTransIntersex peopleAllNot knownPrefer to self-describePrefer not to say 9. Is your gender different to the sex you were assigned at birth? - None -YesNoPrefer not to say 10. Please tell us which sexual orientation you identify with - None -AsexualBisexualGay menHeterosexual / StraightLesbians / Gay womenPansexualAllNot knownOtherPrefer to self-describePrefer not to say 11. Please select your ethnicity - None -ArabAsian / Asian British: BangladeshiAsian / Asian British: ChineseAsian / Asian British: IndianAsian / Asian British: PakistaniAsian / Asian British: Any other Asian / Asian British backgroundBlack / Black British: AfricanBlack / Black British: CaribbeanBlack / Black British: Any other Black / Black British backgroundMixed / Multiple ethnic groups: Asian and WhiteMixed / Multiple ethnic groups: Black African and WhiteMixed / Multiple ethnic groups: Black Caribbean and WhiteMixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups backgroundWhite: British / English / Northern Irish / Scottish / WelshWhite: IrishWhite: Gypsy, Traveller or Irish TravellerWhite: RomaWhite: Any other White backgroundAny other ethnic groupAllNot knownPrefer not to say 12. Please select any of the following that apply to you - None -I have a disabilityI have a long term conditionI am a carerNone of the aboveI prefer not to say 13. Which of the following best describes your financial status? - None -I have more than enough for basic necessities, and a large amount of disposable income, that I can save or spend on extras or leisureI have more than enough for basic necessities, and a small amount of disposable income, that I can save or spend on extras or leisureI have just enough for basic necessities and little elseI don’t have enough for basic necessities and sometimes run out of moneyI don't know/prefer not to say How we use this information The information you share with us will be accessed by Healthwatch Hammersmith and Fulham and shared with Healthwatch England. This helps us spot trends both nationally and locally 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. Please contact us separately if you require a response/advice about your issue. Find out more about how we handle your information in our privacy statement. I understand how my information will be used I understand that my information will be used for the research purposes outlined above. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit