Cancer COVID-19 | Patient Experience Questionnaire

1. About you

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1. What is the first part of your post code? e.g NR14

2. Your gender

Male
Female
Rather not say
I describe myself as:

3. If your treatment takes/took place at a hospital, please tell us which hospitals you use (tick all that apply)?

James Paget University Hospitals NHS Foundation Trust
Norfolk and Norwich University Hospital NHS Foundation Trust
Queen Elizabeth Hospital King's Lynn NHS Foundation Trust
West Suffolk Hospital NHS Foundation Trust
East Suffolk and North Essex NHS Foundation Trust
Cambridge University Hospital NHS Foundation Trust
Other (please specify):

4. What is your age range?

0-15
16-24
25-34
35-44
45-54
55-64
65-74
75-84
85 and over
Rather not say

5. What is your ethnic group?

White
Mixed/Multiple ethnic groups
Black/African/Caribbean/Black British
Asian or Asian British
Other ethnic group
Rather not say

6. Do you have a disability?

Yes
No
Rather not say

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