Equality and diversity monitoring form

Equalities Monitoring Form

The London Ambulance Service is committed to promoting equal opportunities across everything we do. The information you provide on this form will enable us to check that we are fulfilling our duties under the law, to the NHS and to our communities, and help us to improve the quality of service for all users. It will also help us to improve the quality of service to all our service users. This information will remain anonymous and will be used for monitoring and compliance purposes only in line with the Data Protection Act 2018 and UK GDPR. We would be very grateful if you could take a little time to complete this form. If you have any questions about the form, please contact the Patient Experience team on 020 3069 0240 or email: [email protected]

What best describes your gender? * REQUIRED
If you prefer to self-describe please provide this here
Is the gender you identify with the same as the sex assigned at birth? * REQUIRED
What is your age range? * REQUIRED
What is your ethnicity? * REQUIRED
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please select appropriate option.
Any other ethnic group, please write in:
Do you consider yourself to have a disability or long term medical health condition? * REQUIRED
What is your sexual orientation? * REQUIRED
If you prefer to use your own sexual orientation identity, please write in:
What is your religious belief?
If other religion or belief, please write in:
Do you have caring responsibilities? * REQUIRED
If yes, please tick all that apply:
- Primary carer of a child/children (under 18)
- Primary carer of disabled child/children
- Primary carer of disabled adult (18 and over)
- Primary carer of older person
- Secondary carer (another person carries out the main caring role)