Comments Complaints Suggestions

We aim to provide the best possible services to all our residents. There are times when we get this right and we would like you to tell us when this happens. There are also times when we may need to know that some things could be better. When this is the case, we would like you to let us know. Your views and comments are important to us.

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Your Name:

Phone Number
Address/Email
Details	-- Enter Text --

SERVICE IMPROVEMENTS

If you are making a comment about a service we provide do you have any suggestions that would improve this service?	-- Enter Text --

YOUR FEEDBACK

Would you like us to contact you about your comment / suggestion / complaint? If so, what is the best way for us to contact you?	-- Enter Text --

MONITORING INFORMATION Please could you provide some monitoring data? This data will not be disclosed to a third party. We will only use personal information internally for the purposes for which it has been provided.

Please tick one box. Are you female or male?
Which of these age groups apply to you? Please tick one box.
Please tick one box Do you have any long-standing illness, disability or infirmity? (Long standing means anything that has troubled you over a period of time or that is likely to affect you over a period of time).
Are you without a permanent home?
Do you have access to your own method of transport?
Are you registered as unemployed?

Do you provide unpaid care for another person?

To which of these groups do you consider you belong? Please tick one box.
WHITE:

MIXED:

CHINESE:

BLACK OR BLACK BRITISH

ASIAN OR ASIAN BRITISH

OTHER ETHNIC GROUP:

Thank you for taking the time to complete this form.

The information that you provide on this form will be kept confidential in accordance with the Data Protection Act 1998, and will not be shared with any external organisations.

Contact Information

The Partnerships Officer at South Bucks District Council

Tel: 01895 837379
Email: haveyoursay@southbucks.gov.uk