Healthier Together Outpatients programme Recruitment

 

1. I would like to work with Healthier Together on the transformation of the Outpatients services in Bristol, North Somerset and South Gloucesterhsire. *

 

2. I would like to help Healthier Together by: *

 

3. Please complete your details so we can contact you about this important project

 

4. What is your age?

 

5. What is your gender?

 

6. Which race/ethnicity best describes you?

  • White
  • Asian or Asian British
  • Mixed
  • Black or Black British
  • Other Ethnic Group
 

7. Do you consider yourself disabled?

 

8. If you answered yes to the previous question, it helps us to know if your disabilities relate to any of the following (please tick all that apply).

 

9. Do you have any other comments, questions, or concerns?

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