Physical impairment Mental health condition Other Sensory impairment Long-standing illness Do not wish to disclose Learning disability/difficulty Professional background Are you a qualified 1 Yes No healthcare professional? If yes, do you currently 2 Yes No practice? Would you consider your role 3 to include management Yes No responsibilities? AHP Nurse/ midwife Clinical scientist Please specify your Paramedic Dentist 4 professional background Pharmacist Doctor (where applicable) Other Please give specialism: Please specify: General Management HR Please indicate management Finance 5 specialism IT/Informatics (where applicable) Other Please specify: Thank you for taking the time to complete this form. Your replies will be anonymized and will remain confidential
Physical impairment Sensory impairment Learning disability/difficulty Mental health condition Long-standing illness Other Do not wish to disclose Professional background 1 Are you a qualified healthcare professional? Yes No 2 If yes, do you currently practice? Yes No 3 Would you consider your role to include management responsibilities? Yes No 4 Please specify your professional background (where applicable) AHP Clinical scientist Dentist Doctor Please give specialism: Nurse/ midwife Paramedic Pharmacist Other Please specify: 5 Please indicate management specialism (where applicable) General Management HR Finance IT/Informatics Other Please specify: Thank you for taking the time to complete this form. Your replies will be anonymized and will remain confidential