Better Days - Day Opportunities Survey - Page 1 of 11 - Dorset Council

Section 1: About you

1. Are you completing this survey on behalf of someone else?

Yes No

2. How old are you?

14 - 18 yrs 19 - 25 yrs 26 - 39 yrs 40 - 49 yrs 50 - 59 yrs 60 - 65 yrs 66 - 70 yrs 71 years and over Prefer not to say

3. Help us understand a little more about you.

Please select as many of the options below as needed

I have a learning disability I have a physical disability I have autism / Asperger’s syndrome I have a sensory impairment I have a mental health illness I have dementia / memory loss I am lonely / isolated I am a carer I am a carer responding for the person I care for I work in health and social care None of the above, but I have an interest in day opportunities and support Other

if you selected other, please explain