H&F ‘Nothing About Us Without Us’ Disabled Residents Survey 2017

Page 1 of 12

Closes 31 Jul 2017

About You

This survey is for disabled people of all ages living in Hammersmith & Fulham. Please complete this survey if you consider yourself to be a disabled person.

The answers to the next group of questions will help us to see if there are differences between the views of different residents.

We will also use the answers to these questions to help us make sure that we have included a range of disabled people with different backgrounds and life experiences.

All the information you give will be kept completely confidential.

1. In which area of Hammersmith & Fulham do you live?

2. How long have you been living in the Borough of Hammersmith & Fulham?

3. Which impairment / health condition group describes you? (tick as many boxes as you need to)

4. What is your gender?

5. What is your age?

6. What is your ethnic group?

7. What is your religion?

8. What is your Sexual Orientation?

9. As a result of being a disabled person, having a long term illness or health issues do you get any support at the moment? (tick as many as you need to)

10. Which of the following best describes where you live now?

11. Are you currently in employment/ education/ training? (please tick all that apply to you)

12. Are you a refugee?

13. Are you an asylum-seeker?

14. Does your household have access to the internet from home?

15. Is there anything else you would like to add about who you are?