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Please share your experiences 

If you've had a recent experience of health and/or social care services and think there are things that can be improved, please use this form to let us know. 

To understand how we will use your information read the 'How we use this information' at the end of the page.

Complete the survey

1. Choose the area of care you would like to tell us about?
Please select the options that you'd like to talk to us about. You can pick more than one.
What went well? What could have been better?
eg. the GP surgery name or hospital department
4. How easy was it to access the help and support you needed?
5. How would you describe your experience of care?
Sharing your answers to questions 1 - 5?
The NHS Integrated Care Board covering Stoke-on-Trent would like to include, in its quality metrics report, information from residents about health and care services. Do you consent to us sharing your answers to questions 1 - 5? We will never share personally identifiable information, so all answers will be reviewed by a person before sharing.
Sharing your answers to questions 1 - 5?
The Staffordshire and Stoke-on-Trent Adult Safeguarding Partnership Board would like to involve the local community in developing its priorities. Do you consent to us sharing your answers to questions 1 - 5? We will never share personally identifiable information, so all answers will be reviewed by a person before sharing.
6. In relation to this experience please select what best describes you

Tell us a bit about you

It would really help to know a little more about you so that we can better understand how people's experiences may differ. These questions are completely voluntary.

8. Please tell us your gender
10. Please tell us which sexual orientation you identify with
11. Please select your ethnicity
12. Please select any of the following that apply to you
13. Which of the following best describes your financial status?

How we use this information

The information you share with us helps us spot trends 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.

Find out more about how we handle your information in our privacy statement. 

Can we stay in touch? 

We'd love to tell your story and keep you updated about our work and the difference sharing your experiences with us can make. 

Using your story for media

To promote our campaigns we use people's stories to show what needs to change. The media (newspapers, radio or TV) ask if we have people who can their story when we publish a press release about our research. 

Would you be happy for us to contact you about your experience for media purposes or to use your story as a case study in our material? We won’t pass on your name and contact details to the media without speaking to you first about what it involves.

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Sign-up to our mailing list to stay up to date with what people are telling us about health and social care, our advice and information, and our latest reports. You can unsubscribe from our mailing list at any time.

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