Complaint Form

Your details

Title(Required)

First Name(Required)

Last Name(Required)

Address(Required)

Street Address Address Line 2 City County Post Code

Email(Required)

Telephone(Required)

Their details (If you are completing this form on behalf of someone else)

Name

First Last

Address

Street Address Address Line 2 City County Post Code

Telephone

Email

What is your relationship to them?

Please name the department, service or staff member you wish to complain about.(Required)

When did you first become aware of the problem?(Required)

If this was over 12 months ago, please say why you have not complained before.

What do you believe has gone wrong or failed to happen?(Required)

If so, please give brief details of how and when you did that, and what happened afterwards.

What do you believe has gone wrong or failed to happen?(Required)

Please describe how you personally have been affected.(Required)

What do you think should be done to put things right?(Required)

File Upload

If you have any documents, letters, photos etc. to support your complaint, please attach them with this form. If you need any help in completing this Form, please don’t hesitate to contact the Complaints Team (Complaints@clwydalyn.co.uk) or telephone: 01745 536800.

Max. file size: 16 MB.

What is your preferred method of communication?(Required)

Phone

Email

Letter

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