Submit an Issue

Your details

Contact Name

Group / Organisation (if applicable)

Telephone Number

Address

Email Address

I want to be kept informed of progress on my issue.
I want to sign up to the LINk and receive the free monthly newsletter.

Your issue

What issue(s) are you concerned about?
Please note: Give as much detail as possible, month & year it happened,
which Trust or social care service

Has an official complaint been made? Yes No

Please provide details of any action taken to address this issue:

Has this affected your dignity? Yes No
Has this affected your quality of life? Yes No

If yes, please explain:

Do you know of other people who may be affected by this? Yes No

If yes, how many people?

What support could Brighton and Hove LINk give you on this issue? What can be done to improve the situation?

Can you help the LINk deal with this issue? Yes No

If yes, please tick all you could help with:

Attending Meetings   Completing Surveys   Distributing Surveys   Enter & View

Data Protection

The information on this form will be held on a database in accordance with the Data Protection Act 1998. We will use this information only to contact you about LINk activities.

I accept the data protection terms.