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In just three minutes, you can make a difference 

NHS and social care staff are doing everything they can to keep us well during these challenging times, but there might be things that can be improved for you and your loved ones. Please take three minutes to share your story with us.

To understand how we will use your information read the 'How we use this information' at the end of the page.

This survey is also available in Easy Read.

Complete the survey

1. What type of service are you telling us about?
Please select the options that you'd like to talk to us about. You can pick more than one.
For example, the GP surgery name or hospital department
3. Overall, how do you rate your overall experience of this service?
What was good? What could have been better? How did you feel after your care?
Give the approximate date within the last two years
6. In relation to this experience, please select what best describes you

Tell us a bit about you

It would really help to know a little more about you so that we can better understand how people's experiences may differ. These questions are completely voluntary. If you would like us to contact you about any queries you've raised, then please provide your name and email here. Thank you.

10. What gender do you identify as?
11. Please tell us which sexual orientation you identify with
12. Please select your ethnicity
13. Do you consider yourself to have any of the following?
For example, leaflet, website, social media, radio

How we use this information 

The information you share with us helps us spot trends to identify areas for improvement. We may use quotes in our reports, but we will not use any information that will identify you.

As well as your feedback, we also ask you to volunteer some personal information. This helps us to help us understand how different groups experience local health and social care services and supports our focus on improving equality, diversity and inclusion. 

If you are sharing information on behalf of another person, make sure that you have their permission to do so, or the information you do share should be anonymous.

Find out more about how we handle your information in our privacy statement. 

Can we stay in touch? 

We'd love to tell your story and keep you updated about our work and the difference sharing your experiences with us can make. 

Using your story for media

To promote our campaigns we use people's stories to show what needs to change. Sometimes Healthwatch England or the media (newspapers, radio or TV) ask if we have people who can share their story when we publish a press release about our research. 

Would you be happy for us to contact you about your experience for media purposes or to use your story as a case study in our material? Your identity can remain anonymous, and we won’t share any contact details with Healthwatch England or the media without speaking to you first about what it involves.

Please select

If yes, enter your name and email address.