Shaping future support: The Health and Disability Green Paper

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Closes 11 Oct 2021

About You

1. How old are you?
2. What is your sex?
3. Is the gender you identify with the same as your sex registered at birth? (This question is voluntary)
4. What is your ethnic group? (choose one option that best describes your ethnic group or background)
5. Which of the following options best describes how you think of yourself?
6. What is your religion?
7. Where do you live?
8. What is your marital or civil partnership status?
9. What is your highest educational attainment level?
10. Do you have any physical or mental health conditions or illnesses lasting or expected to last for 12 months or more?

If you answered this question with 'No', 'don't know' or 'prefer not to say' then please move to next section marked ‘Chapter 1: Providing the Right Support’.

11. Have you experienced any physical or mental health conditions during childhood lasting 12 months or more?
12. Do any of your conditions or illnesses reduce your ability to carry out day-to-day activities?
13. If yes to the above question, how long has your ability to carry out day-to-day activities been reduced?
14. Do any of these conditions or illnesses affect you in any of the following areas? (please tick as many as apply)