Tell us a bit about yourself

1
Please provide your email address
example@example.com
2
Which category below includes your age below?* This field is required.
under 18
18-24
25-34
35-44
45-54
55-64
65 -74
75 and over
3
What is your gender?* This field is required.
Female
Male
Transgender
Non-binary
Other
Prefer not to say
4
What is your sexuality?* This field is required.
Heterosexual
Gay
Lesbian
Bisexual
Asexual
Prefer not to say
Other
5
How do you best describe your race?* This field is required.
Asian or Asian : British, Indian, Pakistani, Bangladeshi, Chinese / Any other Asian background
Black, Black British, Caribbean or African: Caribbean, African, Any other Black, Black British, or Caribbean background
Mixed or multiple ethnic groups: White and Black Caribbean, White and Black African, White and Asian / Any other Mixed or multiple ethnic background
White: English, Welsh, Scottish, Northern Irish or British, Irish, Gypsy or Irish Traveller, Roma / Any other White background
Other ethnic group: Arab /Any other ethnic group
Prefer not to say
6
What is your current status?* This field is required.
In a relationship, curious about if it is abusive.
In an abusive relationship, working on leaving.
Recently left, still a struggle.
Long left, now stabilised.
Other
7
How did you hear about Get Out Get Love?* This field is required.
Social Media
Internet Search
Charity referral/website
The Get Out Get Love book
Online (other)
Word of mouth
Healthcare service
Poster or leaflet
Print media (newspaper/magazine)
Other
8
If you found out about to us/ were referred by a service, please tell us which onefor example: your GP practice name, or service name
Should be Empty: