Service Please type the service you wish to talk aboutFull experienceSummary of your experience*Rating*PositiveMixedNeutralNegativeWould you recommend the service you were using?YesNoAre you aRelativeService UserService ProviderProfessionalVisitorCarer & RelativeFriend or NeighbourOtherIf otherWhich area of Croydon do you live in? (town/city)Email* Your email will be kept private and you will not be sent any marketing materialI consent to being contacted regarding my feedback by HealthwatchYesNoI confirm I am over the age of 16*YesNoData protection: All data received is in line with General Data Protection Regulation 2018. You can see our policies here. I accept terms and conditions* Yes About youTitleMrMrsMsDrProfFirst nameLast name*Phone number*Mobile phone numberAddressPostcodeEthnicity*WhiteBlackAsian or Asian BritishMix BackgroundChinese or other Ethnic backgroundArabPrefer not to sayGender*MaleFemaleTransgenderPrefer not to sayThe following characteristics are not required but we welcome you to include them so we can carefully monitor responses and make sure we are representative of all of Croydon’s communities.DisabilityYesNoIf yesReligious affiliationSexual orientationMarital statusPhoneThis field is for validation purposes and should be left unchanged.
