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Survey - Care Home Services in Southend

1.  

What experience do you have of care homes?

(Tick all statements that apply to you)

* required

About you

We would like to ask some questions about you. This information will help the council to improve its services and be fair to everyone who lives in Southend-on-Sea. The information you provide will be kept entirely confidential and will never be traced back to you as an individual. The information you provide will be used for statistical and research purposes only and will be stored securely. If there are any questions you do not wish to answer, move on to the next question.

6.  

What is your gender? 

This question is optional, you do not have to say if you prefer not to.
7.  

Age Range

This question is optional, you do not have to say if you prefer not to.
8.  

What is your ethnic group?  

Choose one option that best describes your ethnic group or background 
9.  

Do you consider yourself to have a disability?

This question is optional, you do not have to say if you prefer not to.
10.  

Which of the following best describes your current employment status?

*This information is not made public, but used for demographic purposes.
Select option

*This information is not made public, but used for demographic purposes.

Thank you for your contribution