Service Please type the service you wish to talk aboutFull experienceSummary of your experience*Rating* Positive Mixed Neutral Negative Would you recommend the service you were using? Yes No Are you aRelativeService UserService ProviderProfessionalVisitorCarer & RelativeFriend or NeighbourOtherIf other Which 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 Healthwatch Yes No I confirm I am over the age of 16* Yes No Data 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 name Last name* Phone number*Mobile phone numberAddressPostcode Ethnicity*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.Disability Yes No If yes Religious affiliation Sexual orientation Marital status CommentsThis field is for validation purposes and should be left unchanged.
