Under 18 Patient Consultation Questionnaire Question Title * 1. What is your age? Under 16 16-17 OK Question Title * 2. Which of the following describes your ethnic background? (Tick one answer) White British White Irish White Other Asian or Asian British Indian Asian or Asian British Pakistani Asian or Asian British Bangladeshi Chinese Asian Other White and Asian Other Black or Black British Caribbean Black or Black British African Black Other White and Black Caribbean White and Black African Any Other Ethnicity Prefer Not To Say OK Question Title * 3. What is your gender? Male Female Transgender Prefer Not To Say OK Question Title * 4. What is your sexual orientation? Heterosexual Gay or Lesbian Bisexual Prefer not to say OK Question Title * 5. What is your post code? OK Question Title * 6. Where would you prefer to access local sexual health services? (Please tick one or more) Your GP Local Pharmacy Sexual Health Clinic OK Question Title * 7. Which of the following days would you prefer to attend a young person's clinic? (Please tick one or more) Monday Wednesday Thursday OK Question Title * 8. Which of the following opening times would you prefer to attend a young person's clinic? (Please tick one or more) 3:30pm to 5:30pm 4:00pm to 6:00pm 5:00pm to 7:00pm OK Question Title * 9. What type of appointment would you prefer? (please tick one or more) Booked Appointment Same Day Access Wait To Be Seen / Drop-in OK Question Title * 10. How would you like to receive information about our clinics? (Please tick one or more) Our www.letstalkaboutit.nhs.uk website Twitter Facebook Instagram Other (please specify) OK Question Title * 11. Any other comments? (Please add contact details if you are happy to be contacted about your comments?) OK DONE