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Merger consultation
Your practice
Email*
Which GP surgery are you currently registered with?*
Burngreave Surgery
Sheffield Medical Centre
Your feedback
How do you feel about merging the two practices together?*
If the two practices were to merge, what could we do to make things easier for you?*
Is there anything else you think we should consider, or be aware of?*
If the practices did merge you would be automatically registered with the new merged practice, or you could choose to register with a different GP practice. Would you continue to use this practice or move to an alternative practice?*
I would continue to use this practice
I would move to a different practice
Your details
Please tell us the first part of your postcode (e.g S3, S5)*
S1
S2
S3
S4
S5
S9
Other
What is your sex?
Female
Male
Other
Prefer not to say
Is your gender identity different now to the sex you were assumed at birth?
Yes
No
Prefer not to say
What is your age?
<18yrs
18-65yrs
66-75yrs
>76yrs
What is your sexual orientation?
Heterosexual
Bisexual
Homosexual
Other
Prefer not to say
What is your ethnic background?
Arab
Asian or Asian British - Chinese
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Other Asian background
Black or Black British - African
Black or Black British - Caribbean
Black or Black British - Other Black British
Mixed ethnic group - Asian and White
Mixed Ethnic group - Black African and White
Mixed Ethnic group - Black Caribbean and White
Mixed Ethnic group - multiple ethnic background
Gypsy Traveller
White British
Other white background
Prefer not to say
Do you consider yourself to belong to any religion?
Buddhism
Christianity
Hinduism
Islam
Judaism
Sikhism
No Religion
Prefer not to say
Do you have a disability, impairment or condition? ( Tick all that apply)
Autism
Learning disability
Mental Health condition
Physical disability or problems with mobility
Deaf or hard of hearing
Visual
Long standing health condition or illness
Other
Prefer not to say
Do you provide care for someone else? Such as family, friends or others who are ill, disabled or need support because they are older
Yes
No
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