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* 1. Which hospital did you go to?

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* 2. Which department / clinic did you visit?

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* 3. Today's date is

Date

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* 4. How was your experience in the department / clinic?

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* 5. Anything else you want to tell us?

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* 6. Can we share your comments anonymously?

Anonymous means we wont include your name or details.

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* 7. My age is

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* 8. Are your day-to-day activities limited due to a health problem or disability?

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* 9. What is your gender?

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* 10. Trans is a word used to describe someone whose gender is not the same as what they were assigned at birth.

Do you consider yourself to be a trans person?

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* 11. What is your sexual orientation?

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* 12. What is your ethnic group?

0 of 12 answered
 

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