Plasmawr Road Shopping Area

What was your age on your last birthday?
Under 1616-2425-3435-4445-5455-6475+

Are you…?
FemaleMaleNon-binaryOtherPrefer not to say

If ‘other’ please specify

Do you identify as Trans?
YesNoPrefer to self describePrefer not to say

If you prefer to self describe please specify

Are you pregnant, or have you given birth within the last 26 weeks?
Yes, I'm pregnantYes, I've given birthNoprefer not to say

Do you identify as a disabled person?
YesNoPrefer not to say

Please tick any of the following that apply to you:
Deaf/Deafened/Hard of HearingMental Health difficultiesLearning Impairment/difficultiesVisual ImpairmentWheelchair UserMobility ImpairmentLong-Standing Illness or health condition (e.g cancer, diabetes or asthma)Prefer not to sayOther

Do you regard yourself as belonging to any particular religion?
No, no religionBuddhistChristian (including Church in Wales, Catholic, Protestant and all other Christian denominations)HinduJewishMuslimSikhOtherPrefer not to answer

How would you describe your sexual orientation?
BisexualGay Woman/LesbianGay ManHeterosexual/StraightOtherPrefer not to answer

If ‘other’ please specify

Are you:
SingleIn a same sex civil partnershipMarriedLiving Together/Co-habitingSeparated/divorced or legally separated if formerly in a same sex civil partnershipWidowedOther

Do you speak, read, understand or write in Welsh?
YesNo

Do you speak, read, understand or write in any other language (except English)?
YesNo

If ‘yes’ please specify

What is your ethnic group?
White Welsh/English/Scottish/Northern Irish/BritishWhite - IrishWhite - Gypsy or Irish TravellerWhite - Any other white backgroundMixed/Multiple Ethnic Groups - White & AsianMixed/Multiple Ethnic Groups - White and Black CaribbeanMixed/Multiple Ethnic Groups - White and Black AfricanMixed/Multiple Ethnic Groups - Any otherAsian/Asian Welsh/British - BangladeshiAsian/Asian Welsh/British – ChineseAsian/Asian Welsh/British - IndianAsian/Asian Welsh/British - PakistaniAsian/Asian Welsh/British - Any otherBlack/African/Caribbean/Black Welsh/British - AfricanBlack/African/Caribbean/Black Welsh/British – CaribbeanBlack/African/Caribbean/Black Welsh/British - Any otherArabAny other ethnic groupPrefer not to say

If ‘Any other ethnic group’ please specify