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NHS Health Checks

Closes 13 Sep 2024

About you

The council and partners are committed to ensuring that all of its services are delivered fairly and in compliance with its public sector duties within the Equality Act 2010. The more information you provide, then the more we can learn about customers’ views of our services.

What is your age? Tick one box only.

(Required) 40-44 45-49 50-54 55-59 60-64 65-69 70-75 75+ Prefer not to say

What is your gender? Tick one box only.

(Required) Male Female Prefer not to say

Prefer to self-describe (specify)

What is your ethnic origin? Tick one box only.

White - English/Welsh/Scottish/Northern Irish/British White - Irish White - Gypsy or Traveller

White - any other background (please state)

Mixed - Black Caribbean & White Mixed - Black African & White Mixed - Asian & White

Mixed - any other mixed background (please state)

Asian/Asian British - Indian Asian/Asian British - Pakistani Asian/Asian British - Bangladeshi Asian/Asian British - Chinese

Asian/Asian British - Any other Asian background (please state)

Black/Black British Black/Black British - African Black/Black British - Caribbean

Black/Black British - Any other Black background (please state)

Arab

Any other ethnic group (please state)

Prefer not to say

Registered GP Practice:

Please select your GP Practice (Required)

Home postcode:

Postcode

Have you:

(Required) Received an NHS Health Check Been invited to an NHS Health Check but did not attend

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