9. Overall, how was your experience of our service?

Very good Good Neither good nor poor Poor Very poor Don't know

12. To ensure that all members of our local communities are experiencing fair and satisfactory services from KMPT we would like to ask you to share some personal information about yourself.

Sharing personal information will not affect the care that you receive, but it will help us to deliver services that recognise and meet your needs.

Yes No

13. Which of the following best describes your sexual orientation?

Heterosexual or straight Gay or Lesbian Bisexual I would prefer not to say Other orientation

15. What is your religion?

No religion Buddhist Christian (including Church of England, Catholic, Protestant, and other Christian denominations) Hindu Jewish Muslim Sikh I would prefer not to say Other religion

17. Do you have any physical or mental health conditions, disabilities or illnesses that have lasted or are expected to last for 12 months or more?

Yes No I would prefer not to say

19. At birth were you registered as...

Male Female Intersex I would prefer not to say

20. Is your gender the same as the sex you were registered as at birth?

Yes No I would prefer not to say

22. What is your ethnic group? (please select from the dropdown)

Please type the first few letters... White o English / Welsh / Scottish / Northern Irish / British White o Irish White o Gypsy or Irish Traveller White o Roma Mixed / multiple ethnic groups o White and Black Caribbean Mixed / multiple ethnic groups o White and Black African Mixed / multiple ethnic groups o White and Asian Asian British o Indian Asian British o Pakistani Asian British o Bangladeshi Asian British o Chinese Black / African / Caribbean / Black British o African Black / African / Caribbean / Black British o Caribbean Other ethnic group o Arab I would prefer not to say

23. How old are you?

o Under 18 o 19 - 29 o 30 - 39 o 40 - 59 o 60 - 80 o 80+ I would prefer not to say