Stop It Now! website equality monitoring form

Diversity introduction
Stop It Now! is committed to ensuring that its services, policies and practices are free from discrimination and prejudice and that individuals are treated fairly and according to their needs. Knowing the individual characteristics of our participants can help us to ensure that no one receives less favourable treatment. We would be grateful if you could answer the following survey questions. You are under no obligation to provide the information requested, but it would help us greatly if you did.
The responses to these questions will be held separately from other information that we hold about you and used for statistic and research purposes.

Question Title

* 1. Why did you visit the Stop It Now! website today?

Concerned about your own thoughts and behaviour

Concerned about the behaviour of another adult

Concerned about a child or young person

Professional looking for advice

Adult survivor of abuse

Other (please specify)

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* 2. How old are you?

Under 18 years

18 – 25 years

26 – 35 years

36 – 45 years

46 – 55 years

56 – 65 years

66 years and over

Prefer not to say

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* 3. How would you describe your gender identity?

Male

Female

Prefer not to say

I prefer to use my own terms (please tell us more)

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* 4. Would you consider yourself to have a disability?

Yes

Prefer not to say

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* 5. If you disclosed a disability above, please share with us further information on how this presents itself:

Hearing impairment

Mental health condition

Learning disability/cognitive impairment

Long standing illness or health condition

Neurodiversity such as Autism or ADHD

Visual impairment

Physical impairment

Prefer not to say

Other (please specify)

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* 6. How would you describe your ethnicity?

White, Caucasian or White British

Black, African, Caribbean or Black British

Asian or Asian British

Middle Eastern or Arab

Mixed or Multiple Ethnic Groups

Gypsy/Traveller

Prefer not to say

Other (please specify)

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* 7. How would you describe your Sexual Orientation?

Heterosexual/straight

Gay

Lesbian

Bi-sexual

Prefer not to say

Other (please specify)

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* 8. How would you describe your religious belief?

Christian

Muslim

Sikh

Hindu

Buddhist

Jewish

No religion

Atheist

Prefer not to say

Other (please specify)

Stop It Now! website equality monitoring form

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* 1. Why did you visit the Stop It Now! website today?

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* 2. How old are you?

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* 3. How would you describe your gender identity?

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* 4. Would you consider yourself to have a disability?

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* 5. If you disclosed a disability above, please share with us further information on how this presents itself:

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* 6. How would you describe your ethnicity?

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* 7. How would you describe your Sexual Orientation?

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* 8. How would you describe your religious belief?

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* 9. How can we improve our services to make them more accessible and useful to you?