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Complaints, Compliments and Comments - online form

We want to know what you think so we can improve the services we provide. We also want to know if you are not happy with the service you have received.

Are you making a comment/ compliment/ complaint:

Note: Fields marked with a * are required.

1. Customer details:

Title:

Mr Mrs Miss Ms Other

First name

Surname *

House No. or Name:

Address *

Postcode *

Contact Tel. No.

2. Have you contacted the council before with this matter?

No Yes

If yes, and you know who dealt with you, please write his or her name or the name of the service e.g. Refuse Collection, Repairs, Highways, Benefits:

3. If you are contacting us on behalf of another person, please also fill in the section below with your details...

Title:

Mr Mrs Miss Ms Other

First name

Surname

House No. or Name:

Address

Postcode

Contact Tel. No.

4. Details of your comment, compliment or complaint:

5. Equalities questionaire

Bristol City Council works towards eliminating discrimination and promoting equal opportunities. Collecting the following information can help us to achieve this. Data collected will be used to help us to plan and deliver services more effectively to individuals and service users. It will also be used to report on the needs of different groups of people. Information provided will be treated confidentially and in accordance with the Data Protection Act 1998.

How old are you:

under 18
18 to 24
25 to 39
40 to 64
65 and over

Do you have a disability:

No Yes

Are you:

Lesbian/Gay/Bisexual Heterosexual

Are you:

White British
White Irish
White Other
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Indian
Pakistani
Bangladeshi
Any other Asian background
Caribbean
African
Any other Black background
Chinese
Other ethnic group

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