Compliments form
Name *
Telephone Number
Email Address *
What is your compliment *
Name of staff or department that was helpful
We collect diversity information so we ensure we offer an equal service to all our residents. If you have not already done so, it would be helpful if you could give us the following information. If you have previously supplied this information, there is no need to do so again.
Gender
Male		Female
Sexual orientation
Bisexual		Gay
Lesbian		Hetrosexual
Ethnic origin
White British		White Irish
White other - please state
Mixed: White and Black Caribbean		Mixed: White and Black African
Mixed: White and Asian
Mixed other - please state
Asian British		Asian Indian
Asian Pakistani		Asian Bangladeshi
Asian other - please state
Black British		Black Caribbean
Black African
Black other - please state
Chinese
Other - please state
Disability
Tick this box if you consider yourself to have a disability
Date of birth
Date of birth
Religion
Christian		Muslim
Hindu		Sikh
Jewish		Buddhist
No religion
Other - please state

* Fields marked with a red asterisk are mandatory.

 

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