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* 1. Which hospital site did you attend?

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* 2. Today's date

Date

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* 3. Thinking about your recent visit to A&E...

Overall, how was your experience of our service?

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* 4. What was good about your care, and what could be improved?

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* 5. Are you happy for us to publish your comments anonymously?

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* 6. My age is

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* 7. Are your day-to-day activities restricted due to a health problem or disability?

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* 8. What is your sex?

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* 9. Is your gender identity the same as the sex you were assigned at birth?

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* 10. Which of the following options best describes your sexual orientation?

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* 11. What is your ethnic group?

0 of 11 answered
 

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