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* 1. First name (optional)

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* 2. Age

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* 3. Where do you live?

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* 4. Would you describe yourself as having a disability or long-term health condition?

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* 5. If yes, please can we ask you to select the option from the list below which best describes your disability or long-term health condition?

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* 6. Can you tell us about a recent positive experience of shopping, either in-store or online?

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* 7. Can you tell us, if you have experienced one, about a recent negative experience of shopping either in-store or online?

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* 8. What could retailers do to improve your personal shopping experience? What would you say are the biggest barriers to you being able to both enjoy the experience and make successful purchases, both in-store and online?

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* 9. Have you ever not made a purchase due to a poor shopping experience related to your disability?

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* 10. Would you be happy for us to anonymize your response for use in our training and promotional materials? If yes, we will use your first name only.

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* 11. Are you happy for us to anonymise and use your responses in our research materials?

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* 12. Please leave your email address in the box below if you are happy for the Purple Tuesday team to contact you regarding your responses, or about the wider work of Purple:

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