My issue(s) is/are: Please provide full details such as who experienced the issue, where, when, who else was involved. *
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Tell us briefly what was good, what wasn’t so good about your experience and how it could be improved *
In relation to this experience, please tick the box that best describes you *
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Age *
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Ethnicity *
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Sexual Orientation *
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Marital Status *
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Disability *
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Religion *
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Gender *
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If you answered ‘other’ to any of the previous questions, please provide further details in the freeform box below
Does your gender identity match your sex as registered at birth? *
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Phone number
Please tell us where you heard about Healthwatch Cornwall e.g. press *
Your story could help to raise awareness and encourage others to speak out. Healthwatch Cornwall would like to use your story as a case study or in a relevant press release. Please indicate if you are happy for us to do this. If yes, we may need to call/email you for more information. Thank you. *
