Name:

Address:

Telephone:

Email:

2.  Type of feedback

Complaint
Compliment
Improvement Suggestion

3.  Summary of complaint, compliment or improvement suggestion:

4.  What action have you taken in respect of the matter?

5.  What action would you like us to take?

6.  To enable us to ensure all our residents are fairly treated and have equal access to our services we would be grateful if you can amswer the following question:

Which of these groups do you identify most with?

White, British
White, Irish
White, Other
Black or Black British, Caribbean
Black or Black British, African
Black or Black British, Other
Asian or Asian British, Indian
Asian or Asian British, Pakistani
Asian or Asian British, Bangladeshi
Asian or Asian British, Other
Mixed, White and Black Caribbean
Mixed, White and Black African
Mixed, White and Asian
Mixed, Other
Chinese / Other, Chinese
Chinese / Other, Other
Romany Gypsy

Irish Traveller
Prefer not to say