We are looking for feedback about local services for people on the autistic spectrum

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* 1. Name

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* 2. Share your experiences and suggestions

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* 3. I would like to remain anonymous

Yes

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* 4. Are you?

Adult on the autistic spectrum

Young person on the autistic spectrum

Parent of an adult on the autistic spectrum

Parent of a child on the autistic spectrum

A relative/friend of an adult on the autistic spectrum

A relative/friend of a child on the autistic spectrum

A Teacher/Teaching Professional

A care and support service provider

A health professional

A member of staff who supports someone on the autistic spectrum

Other (please specify)

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* 5. Location

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* 6. Email

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* 7. Phone

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* 8. Please select how you would like to be contacted if you wish to share your experience with us in more detail. By doing so you are agreeing to us using the details provided to contact you directly.

Phone

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* 9. Please read: https://www.healthwatchtelfordandwrekin.co.uk/privacy-policy/ as required under GDPR*

I have read the Privacy Statement.

Please note that if you are under 16 you will need your parents/carers consent for you to share your experience. Please contact us directly at info@healthwatchtelfordandwrekin.co.uk

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* 10. Consent to storing information

I am happy for my information to be used to help improve the Autism Strategy and Action Plan in Telford and Wrekin.

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* 11. Consent to sharing information

I am happy for Healthwatch Telford and Wrekin to anonymously share it with third parties including Telford and Wrekin Council for the purpose of informing the new Autism Strategy and Action Plan.