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Inclusion Strategy Survey - About You
1
. How old are you?
How old are you?
Under 16
16-25
26-35
36-50
51-75
76-85
over 85
2
. What is your gender?
What is your gender?
Female
Male
Trans man
Trans woman
If you describe yourself another way, please write here
3
. Do you consider yourself to have a disability?
Do you consider yourself to have a disability?
Yes
No
Prefer not to say
4
. Your ethnicity:
Your ethnicity:
White British
White Irish
Other White
Black African
White & Black African
White & Black Caribbean
Black Caribbean
Other Black
Chinese
Indian
Pakistani
Bangladeshi
White & Asian
Other Asian
Gypsy/Romany
Roma
Traveller of Irish origin
Other mixed background
Prefer not to say
Other (please specify)
5
. Your sexual orientation:
Your sexual orientation:
Bisexual
Gay man
Gay woman/lesbian
Heterosexual/straight
Other
Prefer not to say
6
. What is your religion or belief?
What is your religion or belief?
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Atheist
None
Other (please specify)
7
. Finally, please tell us whether you consider yourself to be any of the following (please tick all that apply or leave blank if none apply):
Finally, please tell us whether you consider yourself to be any of the following (please tick all that apply or leave blank if none apply):
SECAmb staff member
SECAmb volunteer
Foundation Trust member
FT governor
SECAmb Chaplain
Carer
Staff member from another NHS organisation
Councillor
Patient - rare use of the ambulance service
Patient - regular use of patient transport services
LINk member
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