1. Please tell us which GP practice you are registered with.
| Please select your practice |
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| List of GP practices in Enfield | |
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This question requires an answer
2. Please enter the first part of your postcode e.g. EN1, N13 *
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3. Please tell us your age *
4. Please tell us your gender
5. Are you married or in a same sex civil partnership?
6. Please select the option which best describes your sexuality
7. Please indicate your religion or belief
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8. I would describe my ethnic origin as *
9. Do you consider yourself to have a disability?
10. If you consider yourself to be disabled, please state the type of impairment that applies to you. People may experience more than one type of impairment, so please feel free to tick more than one box. If none of the categories apply, please mark "other" and specify the type of impairment.
11. Do you provide care on a substantial and regular basis for a family member or friend who needs care/help/support because of sickness, frailty or disability?