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Equality and Diversity Monitoring Form

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Equality and Diversity Monitoring

Camberwell Green Surgery wants to meet the aims and commitments set out in our equality policy.

This includes not discriminating under the Equality Act 2010.

The information provided will be kept confidential and will not affect your care in any way.
The information is going to be used to help us understand the diversity of our organisation.

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All questions marked with a * are mandatory

Personal Details

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Equality and Diversity Questions

What is your sex? (at birth): *

Which of the following best describes your gender identity?: *

What is your sexual orientation?: *

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This form collects personal and medical information about you and we use this information to update your records.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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