Patient Survey Patient Survey What is your postcode? Postcode Are you a Patient or a Carer? Patient Carer Both Do you consider yourself to be disabled or have a long-term health condition ? Yes No If yes – please describe. Optional What is your Gender?MaleFemaleNon-BinaryPrefer not to sayWhat is your age bracketUnder 2425-5051-74Over 75What is your ethnicity?White - English, Welsh, Scottish, Northern IrishWhite - IrishWhite - OtherBlack, African, Caribbean or Black British - AfricanBlack, African, Caribbean or Black British - CaribbeanBlack, African, Caribbean or Black British - OtherAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - Any other Asian BackgroundOther ethnic group - ArabMixed or Multiple ethnic groups - White and AsianAny other ethnic groupWhat comments do you have regarding the proposal for the entity change for the Town Surgery from Partnership to Limited Company Status?What do you like about The Town Surgery that you would like to see continue if the proposed change takes place?What do you think could be better or improved at The Town Surgery ?