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Extended Access Service - Patient Input
About You
Knowing a bit more about you helps us to fully understand the information we gather to improve our services.
1.
What age bracket do you fall into?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
Prefer Not to Answer
2.
What gender are you?
Male
Female
Non-Binary
Prefer Not to Answer
Other (please specify)
3.
What is your ethnicity?
Asian/Asian British
Black/Black British/Caribbean/African
Mixed/Multiple Ethnic Groups
Traveller/Roma/Gypsy
White (incl. British, Irish, Other)
Prefer Not to Answer
Other (please specify)
4.
What is your employment status?
Employed - Full-Time
Employed - Part-Time
Self-Employed
Not Employed and Looking for Work
Not Employed and Not Looking for Work
Carer
Retired
Student
Homemaker
Prefer Not to Answer
5.
What is your preferred method of travel?
Car
Bus / Public Transport
Taxi
Bike
Travel by Foot
Prefer Not to Answer
6.
Which GP Practice are you registered at?
Dr Rasool
Kingsway Medical Centre
Marsh House Medical Centre
Melrose Medical Centre
Norton Medical Centre
Queenstree Practice
The Roseberry Practice
