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* 1. Thanks for reporting the problem you have experienced. What was the date of the incident?

Date

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* 2. Who were you trying to contact

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* 3. What is the name of the organisation you were trying to contact?

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* 4. Who were you trying to contact or talking to when the incident occurred?

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* 5. Name of the person you were speaking to if known

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* 6. What Town is the organisation in?

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* 7. What were you trying to do?

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* 8. What kind of Account or service was this about?

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* 9. What should this service have provided to help you communicate properly and avoid this difficulty?

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* 10. What happened?

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* 11. Is this the first time this has happened?

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* 12. How did it impact you?

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* 13. What did you have to do as a result?

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* 14. Did you complain at the time?

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* 15. How did the other party respond?

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* 16. Your name

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* 17. Whatis your preferred contact method?

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* 18. The complaints process particularly in the NHS can be quite involved. How would you prefer us to support you?

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* 19. Thank you for anwering these questions and helping to improve awareness of the needs  of people with a hearing loss.  We will send you a copy of the email we plan to send on your behalf. Can you please let us know if you have a reply by forwarding a copy and any comments you have regarding the reply to info@UKCoD.org.
If you have any queries or concerns please let us know here. Thanks

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