Share your Good News Story with Healthwatch BaNES

Help us spread a little joy – share your good news story!

Winter is here, can you help us spread a little joy by sharing your Good News Story about Health and Social Care. Whilst we have the power to influence for positive change, we also want to celebrate and share all positive experiences too.

If you would like to share your story, please complete this survey

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* 1. What type of service does your good news story relate to? *

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* 2. Please provide the name of the service you are telling us about

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* 3. Your Good News Story

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* 4. Your Details

First Name

Last Name

City/Town

First part of Postcode (i.e. BA1)

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* 5. Do you care for someone who has significant health needs?

Yes

Prefer not to say

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* 6. Gender: How do you identify?

Man

Woman

Non-Binary

Prefer to self-describe, below

Self-describe:

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* 7. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

Prefer not to say

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* 8. How would you describe your ethnicity?

Asian/Asian British - Bangladeshi

Asian/Asian British - Chinese

Asian/Asian British - Indian

Asian/Asian British -Pakistani

Asian/Asian British - Any other Asian Background

Black or Black British - African

Black or Black British - Caribbean

Black or Black British - Any other Black background

Any other Ethnic Groups - Arabic

Any other Ethnic Groups - Iranian

Any other Ethnic Groups - Iraqi

Any other Ethnic Groups - Kurdish

Any other Ethnic Groups - Turkish

Any other Ethic Groups - Any other Ethnic Background

Mixed/multiple ethnic groups - White and Asian

Mixed/multiple ethnic groups - White and Black African

Mixed/multiple ethnic groups - White and Black Caribbean

Any other mixed/multiple background

White - British

White - Eastern European

White - Gypsy

White - Irish

White - Irish or Scottish Traveller

White - Roma

Any other white background

Prefer not to say

Any other ethnic group (please specify)

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* 9. Please add your email address to join our mailing list (if you wish to)

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* 10. We may use your first name and quote your story in publicity. If you would prefer to remain anonymous please tick the box

Don't use my first name