page2
SECTION 1: About you
If you are complaining on behalf of someone else, then they must complete
Section 7 of this form if they are able to.
1.
About you:
Name: Alice Latty___________________________________________________
Address: ___10 Edison Way Wyberton___________________________________
__BOSTON_______________________________________________________ ___
Postcode: _PE21 7SP_________________________________________________
Telephone number: _____01205 310414_______________________________
Email: ___alice@lattybiz.co.uk_________________________________________
How and when would you prefer to be contacted? ________________________
__email_____________________________________________________________
Do you have any special requirements for us to communicate with you? We
will make adjustments for you if we can.
___________________________________________________________________
___________________________________________________________________
Are you being supported by an advocacy organisation? Please provide their
details if you would like us to copy them into our correspondence.
____No______________________________________________________________
We’ll keep in touch with you in whichever way works best for you. However, we
do need to make you aware that with email there is always a small risk of
messages being intercepted. If this is your preferred way for us to contact you,
please let us know by ticking one of the boxes below. As a precaution, and for
added peace of mind, we will also password protect any sensitive documents we
send you.
To confirm you are content for us to email you, please tick this box

If you do not want us to correspond with you by email, please tick this box
