Over The Counter Survey March 2019 -Easy Read version

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Stopping doctors prescribing medicines you can buy yourself questionnaire

Doctors, nurses and chemists in Oldham have rules on what illnesses they can prescribe or give free medicines for.

We want to know what you think of the new rules.

Please read the information first.

Then answer the questions.

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* 1. Choose an answer

Like

Dislike

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* 2. Choose an answer

Yes

No

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* 3. Choose an answer

Yes

No

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* 4. Choose an answer

Yes

No

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* 5. You can write what you think about the new rules here

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* 6. Choose an answer

Yes

No

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* 7. Choose an answer

Yes

No

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* 8. Please tell us why you answered yes or no to question 7

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* 9. Choose an answer

Yes

No

Don't know

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Please tell us why you answered yes or no to question 9

Please tell us why you answered yes or no to question 9

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* 10. You can write your answer here

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* 11. You can tell us here

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* 12. You can tell us here

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* 13. I live in (place name)

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* 14. How many years old are you?

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* 15. I am
(tick all the boxes that describe you)

Black

White

Mixed race

British

Asian

African

Caribbean

Chinese

European

Something not listed:

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* 16. I am a

Boy or Man

Girl or Woman

I don’t want to tell you

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* 17. I am the same gender (sex) I was given at birth

Yes

No

I don’t want to tell you

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* 18. I am in a relationship

Yes

No

I don’t want to tell you

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* 19. My religion is

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* 20. I am

Gay or lesbian

Straight

Bi-sexual

I don’t want to tell you

Something not listed

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* 21. I have a long term illness or disability

Yes

No

I don’t want to tell you

My disability is

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* 22. I work

Yes

No

I don’t want to tell you

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* 23. I am in school, college or university

Yes

No

I don’t want to tell you

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* 24. I am retired

Yes

No

I don’t want to tell you

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* 25. I serve in the army, navy or airforce?

Yes

No

I don’t want to tell you

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* 26. I used to serve in the army, navy or airforce?

Yes

No

I don’t want to tell you

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* 27. I help to look after someone who can’t look after themselves

Yes

No

I don’t want to tell you

If yes, can you tell us who you care for

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* 28. Are you pregnant?

Yes

No

I don’t want to tell you

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* 29. Are you breastfeeding?

Yes

No

I don’t want to tell you