Pharmaceutical Needs Assessment - General Public Survey

  Do you have your medicines dispensed at a pharmacy?
  Yes   No  
       
  Do you have your medicines dispensed at a dispensing doctor's practice?
  Yes   No  
       
  If you use a pharmacy, how often do you use one? (please tick one box only)
  Do you have a regular pharmacy?
  In terms of location, why do you use this pharmacy regularly? (please tick only one box)
 
  If your regular pharmacy was not open, would you.... (please tick only one box)
  If your regular pharmacy didn't have the things you need, would you..... (please tick only one box)
  How do you usually travel to your regular pharmacy? (please tick only one box)
 
 
ABOUT YOU:... We want to make sure that everyone is treated fairly and equally, and that no one gets left out.  That's why we are asking you the following questions.  We won't share the information you give us with anyone else.  We'll use it only to help us make decisions, and improve our services.  If you would rather not answer any of these questions, you don't have to.
  Are you.....?
  How old are you?
 
  To which of these ethnic groups do you feel you belong? (Source 2011 census)
 
The Equality Act 2010 describes a person as disabled if they have a long standing physical or mental condition that has lasted, or is likely to last, at least 12 months; and this condition has a substantial adverse effect on their ability to carry out normal day-to-day activities. People with some conditions (cancer, multiple sclerosis and HIV/AIDS, for example), are considered to be disabled from the point that they are diagnosed.
  Do you consider yourself to be disabled as set out in the Equality Act 2010?
  Please tell us which type of impairment applies to you. You may have more than one type of impairment, so please select all the impairments that apply to you. If none of these applies to you, please select "other", and write in the type of impairment you have.  
 
  Do you regard yourself as having a particular religion or belief?
  If you answered yes to the above, which of the above applies to you:
 

Medway Council collects and processes personal information in order to provide a range of public services. Medway Council respects the privacy of individuals and endeavours to ensure personal information is collected fairly, lawfully, and in compliance with the Data Protection Act 1998.                                                          

Thank you for taking part in this consultation.
If you have any questions about this that you would like to discuss further please contact us at jsna@medway.gov.uk

 
   
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