Complaints Form

Mandatory fields are marked with an asterisk (*)

Your name*

Your address*

Postcode

Your telephone (day)(eve)

Your email

The name of the service and location you would like to make a complaint about (eg Housing, Leisure, Planning)

Have you already complained to the Council?YesNo

If Yes, what is the name and job title (if known) of the person you complained to?

You don't have to complete this part of the form, however so that we can provide equal opportunities for everyone, we would be grateful if you could complete the information below. All information will be treated as confidential and personal information will be used in compiling anonymous statistics only.

Please indicate which applies to you

Gender

Male
Female
Transperson
Prefer not to say

Age

Ethnic Group

Sexuality

Religion and Belief

Disability
The Disability Discrimination Act 1995 defines disability as follow 'A person has 'a disability' if s/he has a physical or mental impairment which has a substantial and long term adverse effect upon his/her ability to carry out normal day to day activities'. 'Substantial' means more than minor or trivial and 'long term' means likely to last for at least 12 months or more.

Do you consider yourself to have a disability?

Yes
No

Prefer not to say

If Yes, please indicate which best describes your disability

People who have the following conditions are automatically treated as disabled

Ipswich Borough Council