NHS70

If you’d like to share your experience with the NHS in Wales over the last 70 years with us, you can do that here

Pe hoffech rannu eich profiad o’r GIG yng Nghymru dros y 70 mlynedd diwethaf medrwch wneud hynny yma

1. Would you like to complete this form in English or Welsh? / Hoffech chi lenwi y ffurflen yn y Gymraeg neu'r Saesneg? *This question is required.

English / Saesneg
Cymraeg / Welsh

2. What is your Welsh Connection? Please tick all those that apply *This question is required.

Born in Wales
Live in Wales now
Born somewhere else but live in Wales now
Studied in Wales
Other (please specify) Please enter an 'other' value for this selection.

2. Beth yw eich cyswllt â Chymru? Rhowch dic gerllaw pob un perthnasol os gwelwch yn dda *This question is required.

Ganed yng Nghymru
Yn byw yng Nghymru nawr
Wedi fy ngeni yn rhywle arall ond yn byw yng Nghymru nawr
Wedi astudio yng Nghymru
Arall (nodwch os gwelwch yn dda) Please enter an 'other' value for this selection.

2. What is your name? *This question is required.

2. Beth yw eich enw? *This question is required.

2. What is your current postcode? *This question is required.

2. Beth yw eich cod post presennol? *This question is required.

2. What is your email address? *This question is required.

2. Beth yw eich cyfeiriad e-bost? *This question is required.

2. What is your birthdate? *This question is required.

Calendar

2. Beth yw eich dyddiad geni? *This question is required.

Calendar

2. Would you like to help us on this #NHS70 project? - if yes, please tell us what you would be interested in doing. It could include sharing your stories for us, or wanting to get involved in helping us to make the project happen. *This question is required.

2. A hoffech ein cynorthwyo gyda’r prosiect #NHS70 hwn? – Os fuasech, a wnewch chi ddweud wrthym beth hoffech ei wneud. Gallai hyn olygu rhannu stori, ynteu gyfrannu at wireddu’r prosiect. *This question is required.

2. What is your connection to the NHS in Wales? Please tick all that apply *This question is required.

I work or have worked in the NHS
I have been a patient in the NHS
I work in an area that supports the NHS
I have a friend or family member who is or who has been a patient of the NHS

2. Pa gysylltiad sydd gennych chi â’r GIG yng Nghymru? Rhowch dic gerllaw pob un perthnasol os gwelwch yn dda *This question is required.

Rwy’n gweithio neu wedi gweithio i’r GIG
Rwyf wedi bod yn glaf o fewn y GIG
Rwy’n gweithio mewn maes sy’n cefnogi’r GIG
Mae gennyf gyfaill ynteu aelod o’r teulu sydd yn, ynteu wedi bod, yn glaf o fewn y GIG

2. Please share your story about the NHS here. *This question is required.

2. Os gwelwch yn dda, rhannwch eich stori ynghylch y GIG yma. *This question is required.

2. Would you like us to contact you further via email or phone to find out more about your stories? *This question is required.

yes by email
yes by phone
no thank you

2. A hoffech i ni gysylltu â chi eto trwy gyfrwng e-bost neu ffôn er mwyn dod i wybod rhagor am eich storïau? *This question is required.

hoffwn trwy e-bost
hoffwn, dros y ffôn
na dim diolch

2. Would you like to leave us a contact phone number for us to chat more about your stories? if so please put your number in the box below.

2. A hoffech roi rhif ffôn cyswllt i ni fedru codi’r ffôn i gael gair pellach â chi am eich storïau? Os felly nodwch eich rhif ffôn yn y bocs isod os gwelwch yn dda.

2. Anything else you would like to tell us or ask us?

2. Unrhyw beth arall yr hoffech ei ddweud wrthym ynteu holi i ni?