Feedback Tell us about your health and care experiences good or bad in places such as: GPs, hospitals, care or nursing homes, day centres, social services, 111 and mental health services. Feedback form What Topics are in your Story?*For example - appointment times, cleanliness, information, staff attitude etcWhat Services are your story about?*List the services used. For example, the name of the GP surgery, hospital, care home, dentist and so on.What Happened?*Tell your story here. What was good? What could have been better? How did you feel about your care.Are you the Patient?*Please say whether you are the patient/service user, a carer, a relative, a visitor, a health or social care professional or something else.How would you rate the quality of care you received?*PoorAverageGoodExcellentPlease say whether you are the patient/service user, a carer, a relative, a visitor, a health or social care professional or something else. Would you Recommend this service to your family or friends?*YesNoWhat is your postcode?We live in a large county and so by sharing your postcode here you will be helping Healthwatch build a detailed picture of the health and social care services across West Sussex.GenderManWomanTrans*AgeUnder 1819 - 6061 - 7070 - 8485+EthnicityWhiteMixedAsianBlackChineseOtherYour Email Address If you give us your email address, we can keep in touch with any feedback or changes to the services you have commented about. It also means we can tell you about any investigations we are conducting and that you may like to contribute to. We will not share your email address with anyone else.EmailThis field is for validation purposes and should be left unchanged.