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Take 5 minutes to share your experiences 

Use the form below to share your experiences, good or bad, about health or social care services in Surrey. The more detail you can give, the more this will help us to build up a picture of people’s experience of services in Surrey.

Your feedback may be shared with those responsible for health and social services in Surrey and may be used in Healthwatch Surrey reports and publications to help influence the way services are delivered in the future.

For information about how your personal data will be processed and stored please refer to our Privacy Statement.

If you are sharing information on behalf of another person, make sure that you have their permission to do so, or the information you do share should be anonymous.

If your message is about general feedback or you just want to get in touch, please Contact us.

You can also request a paper copy of this form to complete or contact our Helpdesk by:

Phone: 0303 303 0023

SMS (text only): 07952 787533

Email: enquiries@healthwatchsurrey.co.uk.

To understand how we will use your information read the 'How we use this information' at the end of the page.

Complete the survey

1. Choose the area of care you would like to tell us about?
Please select the options that you'd like to talk to us about. You can pick more than one.
eg. the GP surgery name or hospital department
What went well? What could have been better?
4. How would you describe your experience of care?

Tell us about the person who this experience relates to:

It would really help to know a little more about you/ the person you are writing about so that we can better understand how people's experiences may differ. These questions are completely voluntary.

6. Please tell us your/their gender
8. Please tell us which sexual orientation you/they identify with
9. Please select your/their ethnicity
10. What is your/their religion or belief
11. Are you/they a carer?
12. Do you/they have a long term health condition, disability or impairment?
13. If yes to the previous question, please select all that apply:

Can we stay in touch? 

We'd love to tell your story and keep you updated about our work and the difference sharing your experiences with us can make. 

I consent to Healthwatch contacting me about my feedback

If yes, enter your name and email address.

I confirm I am over 16 years old
I have read the terms and conditions
The terms and conditions can be found in the footer of the website.
Please select

Thank you

Thank you for sharing your experience with us. Please select the submit button and your information will then be reviewed by our Healthwatch Surrey team.