Have your say

You can help shape NHS and social care services in Richmond. Using the form below, tell us your experiences and concerns in confidence, and we can take action on the things that matter to you. 

No matter how big or small the issue, we want to hear about it.

 

Take 5 minutes to share your experiences. 

The information you share helps us spot trends to identify areas for improvement. We may use quotes in our reports, but we will never identify you. 

As well as your feedback, we also ask you to volunteer some personal information. This helps us to understand how different groups experience local health and social care services and supports our focus on improving equality, diversity and inclusion. 

If you are sharing information on behalf of another person, make sure that you have their permission to do so, or the information you do share should be anonymous.

You can find out more about how we handle your information in our privacy statement. 

1. Choose the area of care you would like to tell us about?
eg. the GP surgery name or hospital department
4. In relation to this experience, please select what best describes you.

Tell us a bit about you

It would help to know a little more about you so that we can better understand how people's experiences may differ. These questions are optional.

6. Please tell us your gender.
10. Please tell us your religion or belief.
11. Please select your ethnicity
12. Please select any of the following that apply to you

If you would like us to contact you about your experience, please leave your name and email below. 

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