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Information for patients survey

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About you

In the following questions, we will ask you to provide some information about yourself. This is to make sure we are hearing from people with different backgrounds and experiences.

All information you share will be anonymised and will only be used for this survey.


1.  

How old are you?

* required
2.  

What is your gender identity?

* required

Maximum 255 characters

0/255

4.  

Which languages do you speak? Please tick all that apply.

* required