For example, what is the name of the GP surgery/dentist/hospital department/care home that you're telling us about.
For example, GP care, mental health, pharmacy.
3. Who does your feedback mainly relate to?
Eg therapists, radiographers, paramedics
5. How would you describe the experience?

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.

9. Please tell us your gender
11. How would you describe your sexual orientation?
12. How would you describe your marital status?
13. Please describe your ethnicity
14. How would you describe your religious beliefs?
15. Do you identify with any of the following? Select as many as you need to.
16. Are any of the following relevant to you?
17. Do you consider yourself to have a disability?
18. If you consider yourself to have a disability, how would you describe it?
19. Do you consider yourself to have a long term condition?
20. If you consider yourself to have a long term condition, how would you describe it?
23. Our monthly email newsletter is a great way to stay up to date with local health and care news. Don't think anything ever changes? When you receive our newsletter, you'll get to see the work we do, and the ways we make a difference. Do you already receive our monthly newsletter?

Add your name and email address below and every month we'll send you our eBulletin newsletter. You'll be the first to hear about opportunities to shape local health and care services. 

We promise we won't bombard you with emails, and you can unsubscribe at any time if you change your mind.  

Yes, please! Sign me up.

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 health and social care services in Milton Keynes, 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. 

In sharing your feedback with us, you are consenting to Healthwatch Milton Keynes (HWMK) using the information you have provided in the following ways:

·         At a local/national level to identify themes in issues across health services nationally and locally.
·         For statistical analysis on the impact of personal characteristics on people’s experiences of health and social care,
·         Anonymously in marketing content on our website, social media and other communications materials.
 

If you would like a member of our team to contact you about your the feedback you've shared today, please fill in our Contact Us form.