Your name
Your email address
Your contact telephone number
Which of these applies to you? Choose all that apply A current or recent user of maternity services in GloucestershireA health professional working with maternity service users, public health professional or NHS Gloucestershire representativeA representative from a voluntary group working with people using maternity servicesAn antenatal/postnatal practitioner or doulaOther (please tell us more in the comment box)
If you are a professional or voluntary organisation representative, please tell us your organisation and job title
Is there anything else you would like to tell us? Any areas of particular interest or reasons for wanting to be involved?
We want to ensure that Gloucestershire Maternity and Neonatal Voices is representative of all families within Gloucestershire, and your answer to these next questions will help us to see how well we are doing that.
Your support with this is really appreciated.
If you do not wish to answer, please scroll to the end and press submit.
Are you: -MaleFemaleTransgenderNon-binaryPrefer to self describePrefer not to say
What is your ethnicity? -AfricanArabBangladeshiCaribbeanChineseEnglish, Welsh, Scottish, Northern Irish or BritishGypsy or Irish TravellerIrishPakistaniRomaWhite and AsianWhite and Black AfricanWhite and Black CaribbeanOther Asian backgroundOther Black, Black British, or Caribbean backgroundOther Mixed or multiple ethnic backgroundOther White backgroundOther ethnic groupPrefer not to say
Which age group are you in? -19 and under20 - 2425 - 2930 - 3536 - 4041+Prefer not to say
What is the first part of your postcode?
Which of the following best describes how you think of yourself? -Heterosexual or straightGay or lesbianBisexualPrefer not to sayOther If other, please specify.
Do you consider yourself to have a disability? NoLearning disabilityLearning difficultyPhysical disabilityHearing impairmentVisual impairmentLong term conditionMental health problemPrefer not to sayOther If other, please specify.
What is your primary language?
Be Kind - We're all in this together to create a welcoming environment. Let's treat everyone with respect. Healthy debates are natural, but kindness is required.
Be Respectful - Make sure everyone feels safe. Bullying of any kind isn't allowed, and degrading comments about things like race, religion, culture, sexual orientation, gender or identity will not be tolerated.
No promotion or spam - Give more than you take to this group. Self-promotion, spam and irrelevant links aren't allowed and will be removed.
Respect everyone's privacy- Being part of this group requires mutual trust. Authentic, expressive discussions make groups great, but may also be sensitive and private. What's shared in the group should stay in the group.
Be engaged - We encourage active discussions including sharing your experience and views. We recognise that your commitments may change over time, and should you no longer wish to actively participate, we would recommend becoming part of our mailing list instead.
What is the group not for - This is not the place to ask for medical advice or advice on individual circumstances. Please do not discuss specific incidents or care.
Please tick to confirm that you agree and will abide by the group rules I agree to follow the MNVP group rules
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