My Erewash


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Comments, Compliments and Complaints Form

Comment, compliment or complaint form
  1. If you want to report a problem in your area (for example dog fouling or graffiti) as opposed to the service you have received from us, you can use our general enquiries form.

    To make a comment, compliment or complaint, please fill in the form below.

    If you have documents that you want to send us you can print off the form.
  2. Are you contacting us about a (*)
    Please tell us if you are contacting us about a comment, compliment or complaint.
  3. Your Title:(*)
    The title field need completing.
  4. Your name(*)
    Please let us know your name.
  5. Your address(*)
    Please enter an address
  6. Your postcode(*)
    Please enter a valid postcode
  7. Daytime telephone number(*)
    Please enter a phone number
  8. Evening/alternative phone number
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  9. Your email(*)
    Please let us know your email address.
  10. Department of service
    Please let us know your name.
  11. Your Message
    Please let us know your message.
  12. What do you think we could do to put things right?
    Please let us know your message.
  13. Have you complained to anyone about this before? If so, to whom and when? (eg. your Councillor / Council Officer):
    Please let us know your message.

  14. You do not have to fill in the sections below but it may help us to make improvements. Please put a tick next to the answer you wish to provide:
  15. At birth were you:

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  16. How do you think of yourself?

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  17. Ethnicity

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  19. Age

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  20. Do you think of yourself as having a disability?
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  21. If you wish, tell us what your disability is
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  22. Sexual Orientation

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  24. Religion or Belief:
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  25. Please enter the characters in the box provided(*)
    Please enter the characters in the box provided
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  26. Data Protection: This form is not secure. Please don't include any confidential or sensitive information on it. We will treat any other personal information you provide in confidence and under the Data Protection Act 1998. We will hold it and only use it for a legal reason or for the purpose it is given. We will only share information when we have your consent or we need to ask another department or partner to respond to a specific comment or request you have made.