* 1. Thinking about your most recent experience of seeing your GP, a nurse, a consultant or other health and care professional:

Did you feel listened to?

* 2. Did you receive clear information about your condition, what would happen next and what other services you could use?

* 3. Did you feel you were given different options to consider?

* 4. Thinking about your experience of interacting with staff working in GP practices, hospitals, pharmacies and other health and care settings, what are the qualities that you value the most? Please select your top three

* 5. If you could give one piece of advice to staff working in GP practices, hospitals, pharmacies and other health and care settings, what would it be?

* 6. Would you be prepared to have care from someone with specialist training about your condition, even if they were not a doctor or registered nurse?

* 7. If no, why not?

* 8. Would you consider a career in healthcare?

* 9. If no (or maybe), why not?

* 10. Would you be interested in joining our new community of patients to improve the quality of health and care services?

* 11. If yes (or if you would like to know more), please give us your email address

* 12. Please help us learn more about you by completing the following questions:

Are you:

* 13. How old are you?

* 14. What is your ethnicity?

* 15. What is your employment status?

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