Pre-Focus Group Questionnaire

Thank you for registering your interest in joining our focus group. Please complete this short questionnaire. A member of the team will be in touch shortly.

Full name(Required)

Age(Required)

Please enter a number from 16 to 25.

If parent or carer please state the age of the young person.

Full postcode(Required)

Only used to verify East Riding residency

Do you consider yourself to have(Required)

Asthma

Diabetes

Epilepsy

Times available for focus groups(Required)

Mornings

Afternoons

Evenings

Dates and times will be agreed prior with participants

Days available for focus groups(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Dates and times will be agreed prior with participants

Do you have any requirements or reasonable adjustments to take part

Is there any other information you wish to share at this point?

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