Falls - questions for individuals

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Falls - questions for individuals

Thank you for participating in our survey which should take about 20 minutes to complete.

We are looking at the issue of falling, the impact that falls have on you and what support you might receive, with the aim of reducing the incidence of falling and the impact that they have.

In our first section, we would like to ask you some questions about yourself.

1. How do you identify yourself?

Female

Male

Transgender

Non-binary

Not listed

I'd rather not say

Clear selection

2. How old are you?

55 - 59

60 - 64

65 - 69

70 - 74

75 - 79

80 - 84

85 - 89

90 and over

I'd rather not say

Clear selection

3. What is your home postcode?

4. Do you consider yourself disabled?

Yes

No - please go to Question 6

Maybe - please go to Question 6

Not sure - please go to Question 6

I'd rather not say - please go to Question 6

Clear selection

5. If you consider yourself disabled, what type of disability do you have? (please select all that apply)

Disability affecting mobility

Disability affecting vision

Disability affecting hearing

A learning disability

Other

I'd rather not say

6. What is your ethnic group?

Indian

Pakistani

Bangladeshi

Chinese

any other Asian background

Caribbean

African

any other Black, Black British or Caribbean background

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed or multiple ethnic background

White English, Welsh, Scottish, Northern Irish or British

Irish

Gypsy or Irish Traveller

Roma

Any other white background

Arab

Any other ethnic group

I'd rather not say

Clear selection

Clear form

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