Diversity Questionnaire

Do you have a membership in a group or organization that cares/exemplifies your interests or needs?*

Please specify your answer with more details.*

Do you think the local services does a good job of communicating with different groups in the workplace?*

I have the impression that I can use local services and that I can receive what I need from them.*

Staff inquire about my specific needs, which are taken into account, and I receive the care I require.*

When I've needed to switch services, the transition has been seamless, and I've been kept informed throughout the process.*

My safety appears to be a priority, and I have not experienced any errors or mistreatment while in their care.*

Screenings, vaccines, and other health services are all available to me.*

I am able to obtain the services I require and have not been denied access to any such such as GPs, hospitals, or community health.*

I'm as educated, supported, and involved in my care as I need to be.*

I have nothing but good things to say about the care I've received.*

If I've had a complaint, it's been addressed professionally and courteously.*

In your opinion what are the most important priorities for equality and diversity within your local national health services?*

What can we do to improve our communication with you and others in your community?*

Have you come across any roadblocks in using or accessing our services?*

YesNo

Was it connected to any of the following reasons?

Please identify your gender.

FemaleMaleOther

Is this the gender you were given when you were born?

YesNo

Do you believe yourself to be disabled or suffering from a long-term illness?

YesNo

Please indicate your age.

Please indicate your sexual orientation.

Please indicate the country that you were born in.

Please describe your religious or philosophical beliefs.

Do you have any more thoughts or suggestions?