Copy of Equality Monitoring questionnaire - Anonymous collection

Why we collect this information

DPHA is committed to promoting equality, diversity and inclusion across our services.
By completing this voluntary survey, you help us understand the needs of our community, identify barriers, and improve the services we provide.
All responses are anonymous and used for statistical purposes only.

Question Title

* 1. What age are you?

16-24

25-34

35-44

45-54

55-64

65+

Prefer not to say

Question Title

* 2. Please tick the box which best describes your belief or religion from the list below

Buddhist

Christian - Catholic

Christian - Protestant

Hindu

Jewish

Muslim

Other Christian Denominations

Sikh

No specific belief (for example atheism or agnosticism)

Other belief (for example humanism)

Prefer not to say

Question Title

* 3. Do you consider yourself to have a disability or long‑term health condition?

Yes

if yes please tick the box which category you would use to from the following list:

Learning disabilities

Mental health issue (for example bi-polar, depression)

Neuro-divergent condition (for example Autistic spectrum, Dyslexia, Dyspraxia)

Physical impairment (for example wheelchair user, cerebral palsy)

Sensory impairment (hearing impairment, visual impairment)

Long term health condition

Other

Prefer Not to Say

Question Title

* 4. Ethnicity - Please tick the box that best describes your particular group

African, African Scottish, African British including Caribbean

Other African background

Asian, Scottish Asian or British Asian including Indian, Bangladeshi, Pakistani, Chinese

Any other Asian background

Scottish

English

Irish

Welsh

Gypsy/Traveller

Roma

White European

Any other White background

Arab, Arab Scottish or Arab British

Other group - Please specify your ethnic group

Prefer not to say

Question Title

* 5. What is your gender?

Male

Female

Non Binary

Transgender

Prefer not to say

Question Title

* 6. How would you describe your sexual orientation? How would you describe your sexual orientation?

Heterosexual / Straight

Gay / Lesbian

Bisexual

Other

Prefer not to say

Question Title

* 7. What is your relationship status?

Single

Married

In a Civil Partnership

Divorced

Widowed

Prefer not to say