Fill in this form to capture information about who you are and what matters to you. You can share this form with new healthcare professionals who get involved in your care. It will help them to understand you as a person so that they can meet your needs as well as possible.

There are two initial questions where you select responses from a list of options. Then you can provide freetext information about other aspects of your life. You do not need to answer every question.

At the end, you have the option to save your responses as a report. You can then print, save and email your report.