Share your views

Please share your experience with us

NHS and social care staff are doing everything they can to keep us well during these challenging times, but there might be things that can be improved. Your feedback can help service providers to spot issues that are affecting care for you and your loved ones.

You don't have to answer all the questions if you do not wish to.

Your name

Please enter your name.

Your email address *

Please enter your email address, or a phone number if you prefer.

What area of care would you like to talk to us about? *

Select the area(s) of care that you would like to share your views on from the list above.

Name of service

If applicable, please enter the name of the service you would like to tell us about.

Your experience *

Please tell us about your experience here.

Where you live *

North Warwickshire

Nuneaton & Bedworth

Rugby

Warwick District (including Leamington and Kenilworth)

Stratford District (including Shipston and Alcester)

What district best describes where you live?

Where did you hear about Healthwatch Warwickshire?

How would you rate your care experience? *

In relation to this experience, please select what best describes you? *

I’m the person who received the care

I’m providing this feedback on behalf of a friend or relative, or because I’m their carer

Other

Tell us a bit about you

By telling us more information about yourself, you will help us better understand how people's experiences may differ depending on their personal characteristics. If you do not wish to answer these questions you do not have to, however, please don't forget to scroll to the bottom and click submit.

Please tell us your age

Please tell us which gender you identify with

Is your gender different to the sex you were assigned at birth?

i.e. Are you a different gender now compared to what it was when you were born?

Please tell us which sexual orientation you identify with

Please select your ethnicity

If other, please specify

Please select which religion or belief you identify with

If other religion, please tell us more

What is your current partnership (or relationship) status?

Please select any of the following that apply to you:

How we use this information

The information you share with us will be accessed by Healthwatch England. This helps us spot trends both nationally and locally 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 local health and social care services 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.

I understand how my information will be used *

I understand that my information will be used for the research purposes outlined above.

Please see our Privacy Terms & Conditions for more information.

Share your views

Tell us a bit about you

How we use this information

Thank you for your time!

How does sharing your views make a difference?