Northern Ireland Veterans Health Questionnaire

This questionnaire is to gain accurate detailed information to support the future development of healthcare services for veterans in Northern Ireland. The questionnaire should take around 5-15 minutes depending on personal circumstances. Alternatively, you can download the questionnaire (PDF).

Please note, your Service number will ONLY be used as a reference number and proof of service – this Office does not have access to records to identify a person by their service number. Information obtained from this questionnaire will ONLY be used for statistical purposes in support of identifying healthcare needs for all living in Northern Ireland.

Service Number(Required)

(Used for reference purposes only)

Who did you serve with?

Royal Navy

Army

Royal Air Force

Reserves/TA

Branch/Regiment/Arm(Required)

Length of service?(Required)

(Year e.g. 1997-2005)

What age are you?(Required)

What conflicts did you serve in?

N Ireland

Falklands

Kosovo/Bosnia

Afghanistan

Iraq

Other

Other conflicts(Required)

Where do you live?(Required)

County(Required)

Health Trust(Required)

Physical health

What is the nature of your physical health condition?(Required)

e.g. Knee injury – Require knee replacement – on waiting list.

If applicable, has your physical health condition/s been formally diagnosed?(Required)

Yes

No

N/A

Are you satisfied with the health care you are receiving?(Required)

Yes

No

If not, what could be done to help improve your situation?(Required)

Mental health

What is the nature of your mental health condition / conditions?(Required)

e.g. Depression – managed by medication

If applicable, has your mental health condition been formally diagnosed?(Required)

Yes

No

N/A

Are you satisfied with the mental health care you are receiving?

Yes

No

If not, what could be done to help improve your situation?

Would you like to be contacted by the NI Veterans Commissioner’s Office
to be informed of veteran friendly services available in your area?

Please share your email address / phone number and we will contact you as soon as possible.

Name

First Last

Email(Required)

Phone number

Email

This field is for validation purposes and should be left unchanged.

General questions on health

Physical health

Mental health

Healthcare