Patient and Community Engagement survey

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* 1. Full name

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* 2. Email address

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* 3. Phone number (with code)

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* 4. Preferred contact method

Phone

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* 5. Are you registering as a:

Patient

Patient advocate

Community member

Healthcare professional

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* 6. Age group

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 7. What is your current occupation or field?

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* 8. Do you work in healthcare or a related field?

Yes

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* 9. Do you have any prior experience serving on committees or initiatives?

Yes

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* 10. If yes, please provide brief description of your previous experience:

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* 11. Do you currently have any medicolegal issues or conflicts of interest involving Moorfields Eye Hospital Dubai?

Yes

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* 12. If yes, please provide a brief explanation:

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* 13. Are you available to attend committee meetings:

In-person

Virtually

Both

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* 14. How Often would you be able to commit to meetings and activities?

Weekly

Monthly

Quarterly

Semi - annually

As needed