Every winter the NHS has to cope with extra pressures - from more bugs like norovirus or flu making us ill, to even bad weather leading to accidents.
This winter, we'd like you to help us tell the story of A&E departments and the NHS with your own personal experiences.
We'd like you to answer the few questions below. This isn't a survey - despite the name - or scientific in any way, but your responses will help us to understand your story.
We won't pass on any information you provide or use it without contacting you first.
You can also contact us directly by email: firstname.lastname@example.org