The purpose is to help us to make sure that what we are offering young lesbians is what you need, to improve the service and to help us get better support for young lesbians.

Date:

Age:

Name:

Address:

Where did you get our number/address?

Please state which county you live in:

Is where you live (please tick):

Rural

Semi-rural

Small town

Large town

City

Have you spoken to anyone about being lesbian? Yes/no.

If yes, who and what happened?

Do your parents know you are lesbian? Yes/no.

If yes, what happened?

If no, do you have any idea what your parents might think about homosexuality?

Have you told anyone at school/college/work that you are lesbian? Yes/no.

If yes, what was their response?

How old were you when you first thought you were 'different' (you may not have called yourself lesbian/gay)?

What have you read about being lesbian?

Is there a lesbian/gay helpline or support group near where you live? Yes/no.

If yes, how far away is it?

Have you tried to contact them and what happened?

Do you know any lesbians/gays? Yes/no.

We need to know who is using our service, would you please answer the following?

What is your ethnic origin:

Asian

African/Caribbean

Mixed Race

White

Other

What is your class origin:

Lower working class

Upper working class

Lower middle class

Upper middle class

Upper class

Do you have a disability, yes/no? If yes, what?

What is your religion?

Are you a religious person? Yes/no.

NB We will not use this information in any way that will identify you.