Indicates required field Take five minutes to share your experiences 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 five 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. Complete the survey 1. Choose the area of care you would like to tell us about? GP services Dentist Pharmacies Hospital inpatient (day treatment or overnight) Hospital outpatients' appointments Mental health support Social care eg care homes, and home care Accident and emergency/minor injury units Ambulances and paramedics NHS 111 Other issue/service (if other, please tell us which issue/service you are referring to) Please select the options that you'd like to talk to us about. You can pick more than one. If other, please tell us which issue/service you are referring to 2. Please tell us about your experience What went well? What could have been better? 3. Does your feedback apply to a specific service? If so, please tell us which ones(s). eg. the GP surgery name or hospital department 4. How would you rate your experience of care? Excellent Good Okay Poor Very poor Mixed Don't know/not sure 5. How likely are you to recommend this service? Extremely likely Likely Neither likely not unlikely Unlikely Extremely unlikely Unsure 6. "It was easy to access care" Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree N/A 7. "I found the staff friendly" Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree 8. "I received information about the service" Strongly agree Agree Neither agree nor disagree Disagree Strongly Disagree 9. In relation to this experience please select what best describes you I’m the person who received the care I’m providing this feedback on behalf of a friend or relative, or because I’m their carer Other 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. 10. Please tell us your age - None -0 to 12 years13 to 15 years16 to 17 years18 to 24 years25 to 49 years50 to 64 years65 to 79 years80+ yearsPrefer not to say 11. Please tell us your gender 11. Please tell us your gender - None -WomanManNon-binaryPrefer not to sayPrefer to self-describe Enter other… 12. Is your gender identity the same as your sex recorded at birth? - None -YesNoPrefer not to say 13. Please tell us which sexual orientation you identify with 13. Please tell us which sexual orientation you identify with - None -AsexualBisexualGay manHeterosexual / StraightLesbian / Gay womanPansexualPrefer not to sayPrefer to self-describe Enter other… 14. Please select your ethnicity 14. Please select your ethnicity - None -ArabAsian / Asian British: BangladeshiAsian / Asian British: ChineseAsian / Asian British: IndianAsian / Asian British: PakistaniAsian / Asian British: Any other Asian / Asian British backgroundBlack / Black British: AfricanBlack / Black British: CaribbeanBlack / Black British: Any other Black / Black British backgroundMixed / Multiple ethnic groups: Asian and WhiteMixed / Multiple ethnic groups: Black African and WhiteMixed / Multiple ethnic groups: Black Caribbean and WhiteMixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups backgroundWhite: British / English / Northern Irish / Scottish / WelshWhite: IrishWhite: Gypsy, Traveller or Irish TravellerWhite: RomaWhite: Any other White backgroundPrefer not to sayAny other ethnic group Enter other… 15. Please select your religion 15. Please select your religion - None -AtheistBuddhistChristianHinduJainJewishMuslimSikhPrefer not to say Any other religion Enter other… 16. Please select any of the following that apply to you I have a disability I have a long term condition or health and social care need I am a carer None of the above I prefer not to say 17. Which of the following best describes your financial status? I have more than enough for basic necessities, and a large amount of disposable income, that I can save or spend on extras or leisure I have more than enough for basic necessities, and a small amount of disposable income, that I can save or spend on extras or leisure I have just enough for basic necessities and little else I don’t have enough for basic necessities and sometimes run out of money I don't know/prefer not to say 18. Do you know how to make a complaint about health and social care? Yes No 19. Please tell us which part of the borough you live in 19. Please tell us which part of the borough you live in - None -AlpertonChurch EndCricklewood and Dollis HillHarlesdenKensal Green and Kensal RiseKentonKilburnKingsburyNeasden and Dudden HillPreston and UxendonStonebridgeSudburyTwyford and Park RoyalWembley and TokyngtonWillesden GreenOther… Enter other… Sign-up to our mailing list Sign-up to our mailing list to stay up to date with what people are telling us about health and social care, our advice and information, and our latest reports. You can unsubscribe from our mailing list at any time. I want Healthwatch Brent to email me about advice and information, latest news, research and updates. I do not want Healthwatch Brent to email me about advice and information, latest news, research and updates. Name Email 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. CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit Leave this field blank