Ethnic Black or Black British Caribbean British (including Scottish and African Irish Other Black background Other White background Mixed Asian or Asian British White & Black Caribbean Indian White & Black African Pakistani White & Asian Bangladeshi Other mixed background Chinese Other Asian background Other First language Arab Gypsy / Romani / Irish Traveller English Other Ethnic Group Translator required Do not wish to disclose Other (please specify) Nationality Poland UK National Resident in UK Slovakia UK National Returning from Residence Overseas Slovenia Czech Republic Bulgaria Estonia Romania Hungary Other European Economic Area Contry Latvia Any Other Country Lithuania Declined to Answer Question Disability Yes No Don’t know If YES, please tick all that apply Mobility Mental Health Progressive Disability/Chronic illness Autistic Spectrum Condition Visual Impairment Other Hearing Impairment Do not wish to disclose Learning Disability Sexual Orientation Gender Transgender Lesbian Heterosexual Male Do not wish to disclose Gay man Do not wish to disclose Female Bisexual Other Age Religion Sikh 13 36 45 Christian Buddhist – 16 -17 46 55 (all denominations) None – 18 25 56 - 65 Jewish Not known – 26 35 66 + Muslim Any other religion – Hindu Do not wish to disclose Is the Client ex-armed forces personnel (e.g. Army, RAF, Royal Navy) Yes No Don’t know Do not wish to disclose
Ethnic British (including Scottish and Irish Other White background Asian or Asian British Indian Pakistani Bangladeshi Chinese Other Asian background Black or Black British Caribbean African Other Black background Mixed White & Black Caribbean White & Black African White & Asian Other mixed background Other Arab Gypsy / Romani / Irish Traveller Other Ethnic Group Do not wish to disclose First language English Translator required Other (please specify) Nationality UK National Resident in UK UK National Returning from Residence Overseas Czech Republic Estonia Hungary Latvia Lithuania Disability Yes No Don’t know If YES, please tick all that apply Mobility Progressive Disability/Chronic illness Visual Impairment Hearing Impairment Learning Disability Poland Slovakia Slovenia Bulgaria Romania Other European Economic Area Contry Any Other Country Declined to Answer Question Mental Health Autistic Spectrum Condition Other Do not wish to disclose Gender Male Female Transgender Do not wish to disclose Sexual Orientation Lesbian Gay man Bisexual Heterosexual Do not wish to disclose Other Age 13 16 -17 18 – 25 26 – 35 36 – 45 46 – 55 56 - 65 66 + Religion Christian (all denominations) Jewish Muslim Hindu Sikh Buddhist None Not known Any other religion Do not wish to disclose Is the Client ex-armed forces personnel (e.g. Army, RAF, Royal Navy) Yes No Don’t know Do not wish to disclose