Talkback Bexley

Recruitment Questionnaire

We are always looking for more people to join the TalkBack Bexley panel. If you wish to join please complete this questionnaire and return it to us by clicking the "submit" button at the end.

This will help us find out whether we are getting the views of a wide variety of people.

All the information you give us is confidential and we will never use your name in any of our findings. Your data will be held securely in accordance with the Data Protection Act 1998. It will only be used for the purposes described and will not be published on an individual basis. What's more, any time you wish to leave TalkBack Bexley - for whatever reason - simply contact us.

We look forward to hearing from you.

Please answer the following questions

Your name:

Your address:

Your postcode:

Your telephone number:

Your mobile number:

Your email address:

Your year of birth:

Are you?

Would you describe yourself as having a disability?

Which of these best describes your ethnic origin?

Would you like to receive either….
Postal questionnaires OR
Online questionnaires

Please provide an email address for online questionnaires if you have not done so above:

Would you like to receive text questions (no more than once a month)?
Yes
No

If yes, please provide a mobile number if you have not done so above:

Would you like to attend occasional focus groups?
Yes
No

Thank you for taking the time to complete this questionnaire.

Please your details. Thank you.