Have Your Say Feedback Form

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	Have Your Say Feedback Form

Have Your Say Feedback Form

Tell us what you think about our services by filling in our online feedback form, below:

Title:
First name:
Surname:
Address:
Postal code:
Contact Tel. Number:
Email address:
Name of section/service concerned:
Is a reply required?	Yes No

Please state your preferred method of contact:

Other - Please give details

Please state the nature of your feedback:
Your feedback (please give as many details as possible):

Equal Opportunities (Optional)

Are you male or female?	Male Female
How old are you?	Under 18 18-24 25-44 45-59 60-64 65-74 75 or over
Do you consider yourself a disabled person?	Yes No
Which would you say best describes your ethnic origin?	British Irish Other White background White & Black Caribbean White & Black African White & Asian Other mixed background Indian Pakistani Bangladeshi Other Asian background Black Caribbean Black African Other Black background Chinese Gypsy/Roma Traveller of Irish Heritage Other ethnic group
Which religion are you?	Buddhist Christian Hindu Jewish Muslim Sikh None Other
What is your sexual orientation?	Heterosexual/Straight Gay Man Lesbian/Gay Woman Bisexual Other Prefer not to say

The information you have supplied will only be used to help us handle your feedback more effectively and to improve the service to our customers. It will not be shared outside the Council without your consent. The information which you have supplied for monitoring purposes will not be used in any form which you can be identified. The data will only be kept for a period of 5 years.