Please tell us about your experience. (For example, what went well and what could have been better?)
If you'd rather be anonymous, avoid including things that can identify you.
When did this experience happen?
* Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day
Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month
Year 2021 2022 Year
If you are telling us about more than one experience, please give us the date of your most recent experience. If you are telling us about a long delay for treatment - please put today's date.
Please tell us which county or city you live in?
* Please tell us a little bit about yourself
By telling us more information about yourself, you can help us better understand how people's experiences may differ depending on their personal characteristics. You don't need to answer these questions if you don't want to.
How old are you?
- None - 16 to 17 years 18 to 24 years 25 to 49 years 50 to 64 years 65 to 79 years 80+ years Prefer not to say What was your sex recorded at birth?
How would you describe your gender identity?
- None - Woman Man Non-binary Prefer to self-describe Prefer not to say
How would you describe your sexuality
- None - Asexual Bisexual Gay man Heterosexual or straight Lesbian / Gay woman Prefer to self describe Prefer not to say
How would you describe your ethnicity?
- None - Arab Asian or Asian British: Bangladeshi Asian / Asian British: Chinese Asian / Asian British: Indian Asian or Asian British: Pakistani Asian / Asian British: Any other Asian / Asian British background Black / Black British: African Black / Black British: Caribbean Black / Black British: Any other Black / Black British background Mixed / Multiple ethnic groups: Asian and White Mixed / Multiple ethnic groups: Black African and White Mixed / Multiple ethnic groups: Black Caribbean and White Mixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic groups background White: British / English / Northern Irish / Scottish / Welsh White: Irish White: Gypsy, Traveller or Irish Traveller White: Roma White: Any other White background Any other ethnic group Prefer not to say Do you have a disability?
Do you have a long-term condition?
Do you provide unpaid care or support for a family member or friend?
Which of the following best describes your current financial status?
How did you hear about us?
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. 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? We won’t pass on your name and contact details to the media without speaking to you first about what it involves.
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.
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* More advice or information
Do you want someone from our Information team to contact you? This could be so they can give you information about services that could help with the experience that you've shared with us.
Please select one of these options.
Please select info team
* Your contact details
If you have answered yes to any of the three questions above, please tell us your contact details.
Your email address
Your phone number