Name

Email Address

Telephone Number

Address

Postcode

Age Group Age GroupUnder 1617 - 2425 - 3435 - 4445 - 5455 - 6465 - 7475 - 84Over 84

Ethnicity EthnicityWhite - BritishWhite - IrishMixed - White & Black CaribbeanMixed - White & Black AfricanMixed - White & AsianAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiBlack or Black British - AfricanChineseOther Ethnic Group

Which surgery do you normally attend? Which surgery do you normally attend? Brockwell Surgery Seaton Terrace Surgery Seaton Sluice Surgery Lintonville Surgery Morpeth Surgery Lynemouth Surgery Newbiggin Surgery Pegswood Surgery

Gender Gender Male Female

How often do you visit the surgery? How often do you visit the surgery? Regularly Occasionally Very rarely