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Introduction

We are Healthwatch Stockton-on-Tees. We work to make sure local health and care services are the best they can be for the people who use them.

We want to know if you think there are things that health and care services can do to improve.

Please answer these questions to tell us.

How we use your information

We will use the information you give us to spot things that could be better.

We might use the things you say in reports, but we will not use your name.

If you are giving us information for someone else, make sure you have asked them first.

You can find out more about how we use your information on this website: www.healthwatchstocktonontees.co.uk/privacy

Please tell us what happened to you.

Think about:
What went well?
What could have been better?

Are you talking about a particular service, like a part of a hospital or your local doctor?

If so please tell us which one.

How easy was it to get the help and support you needed?

Very easy

Easy

Neither easy nor difficult

Difficult

Very difficult

None of these

How good would you say your care was?

Good

Neither good nor bad

Bad

Sometimes good, sometimes bad

Not sure

None of these

Are you...

The person who got the care

A friend, family member or carer of the person who got the care

Someone else

About you

It would be helpful to know more about you.

This helps us see if different people get better or worse care.

You do not have to answer these questions.

How old are you?

16 to 17 years old

18 to 24 years old

25 to 34 years old

35 to 44 years old

45 to 54 years old

55 to 64 years old

65 to 74 years old

75 years old or older

Prefer not to say

What is your gender?

Gender is whether you like to be known as male, female or something else.

Woman

Man

Non-binary – this means you are not a woman or a man

Prefer not to say

I prefer to use my own word (please write this in the box below):

This is required

Is your gender the same as the one you were given when you were born?

Yes

Prefer not to say

What is your sexual orientation?

Sexual orientation means which gender you are attracted to. For example, male, female or both.

Asexual – this means you are not attracted to anybody

Bisexual – this means you are attracted to men and women

Gay man – this means you are a man who is attracted to other men

Heterosexual or straight – this means you are attracted to the opposite gender

Lesbian or gay woman – this means you are a woman who is attracted to other women

Pansexual – this means you are attracted to people no matter their gender

Prefer not to say

I prefer to use my own word (please write this in the box below):

This is required

Are any of these true for you?

I have a disability

I have had a health condition for a long time

I am a carer

None of these

Prefer not to say

How much money do you have?

I have plenty to spend on things I need, and plenty left for extras I want

I have enough to spend on things I need, and a small amount for extras I want

I have enough to spend on things I need, and not much else

I don't have enough for things I need and sometimes run out of money

I don't know

Prefer not to say

What area do you live in?

Can we contact you?

Getting emails from us

Would you like us to email you with information about what we are doing?

You can stop getting emails from us at any time.

Yes

If you ticked yes, please write your name and email address below.

Name

Email address

HWS Easy Read - Have your say

What kind of service would you like to tell us about? You can pick more than one.

Please tell us what happened to you.

Think about:
What went well?
What could have been better?

Are you talking about a particular service, like a part of a hospital or your local doctor?

If so please tell us which one.