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Sexually Transmissible Infection and Blood-borne Viruses Clinical Services Survey

Closes 14 May 2026

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Background Information

1. How do you describe your gender?

(Required) Woman or female Man or male Non-binary I use a different term Prefer not to say

If you use another term, tell us here:

2. What was your sex recorded at birth?

Female Male Another term (please specify below)

Please specify here

3. Which age group do you belong to?

(Required) Under 15 years 15-34 years 35-54 years 55-74 years 75 years or older Prefer not to say

4. Were you born in Australia or overseas?

Australia Overseas

5. Do you speak a language other than English at home?

No, English only Yes

If you answered "Yes", which language or languages do you usually speak at home?

6. Are you of Aboriginal or Torres Strait Islander origin? (please select one item)

No Yes, Aboriginal Yes, Torres Strait Islander Yes, Aboriginal and Torres Strait Islander

7. Do you have a disability or ongoing condition that makes everyday activities more difficult for you, and has lasted, or is likely to last, at least 6 months?

Yes No Prefer not to say

8. In which region of WA do you live?

Perth Peel South West Great Southern Wheatbelt Gascoyne and Mid West Goldfields–Esperance Pilbara Kimberley Interstate

9. Please tell us a bit more about where you live. Choose from the following:

Perth A large regional town A small regional community

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For more information, contact HealthPolicy@health.wa.gov.au

www.healthywa.wa.gov.au

www.health.wa.gov.au

Acknowledgement of Country
The Government of Western Australia acknowledges the traditional custodians throughout Western Australia and their continuing connection to the land, waters and community. We pay our respects to all members of the Aboriginal communities and their cultures; and to Elders both past and present.