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* 1. What is your age?

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* 2. Do you consider that you have a disability?

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* 3. Responsibilities for others 

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* 4. What is your gender? 

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* 5. Marital status

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* 6. Sexual Orientation

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* 7. Faith or belief

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* 8. Your ethnic group

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* 9. Are there any barriers to you accessing our services?

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* 10. Your relationship with us

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