Use this form to make a comment, compliment or complaint about adult social care services.

To make a comment or complaint about other Nottinghamshire County Council services see the council-wide complaints page.

To comment about Nottingham City Council visit their website.

All questions marked with an * must be answered.

* Would you like to make

a compliment, a complaint or a comment

* What would you like to say?

What could the County Council do about it?

Further information

Which department, section, office, person would you like to have a say about?

* Have you contacted the County Council before about this matter? Yes No

When was this?

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* Name:
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If you prefer corresponds by e-mail please tick this box and provide e-mail address.
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for our information please could you tick all the appropriate boxes.

Are you:	Male Female Male to female transgender Female to male transgender
Disabled:	Yes No
Your age:	Under 5s 5-10 11-15 16-25 26-35 36-45 46-55 56-65 65 and over
Your sexual orientation:	Lesbian Gay Bisexual Heterosexual/Straight

To comply with the Race Relations (Amendment) Act 2000,
we are required to ask you to complete the following. Are you:

1. White

British Irish Gypsy/Romany Other white

2. Mixed

White and Black Caribbean White and Black African

White and Asian Other Mixed

3. Asian and Asian British

Indian Pakistani Bangladeshi Other Asian

4. Black or Black British

Caribbean African Other Black

5. Other ethnic group

Chinese Other Ethnic Group

Your religion or belief:

Christian Hindu Jewish Sikh Muslim Buddhist No religion

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