Citizens Advice Email Request Form

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Please use the form below to request a member of the Citizens Advice team to contact you about your issue.

Contact details

This form is for residents of Reigate and Banstead. If you are in another area, you can find your nearest Citizens Advice here https://www.citizensadvice.org.uk/about-us/contact-us

Please use https://www.gov.uk/find-local-council to find your local council and Citizens Advice

Title *

Miss

Mrs

Prof

Rev

Full Name *

What is your Date of Birth? *

YYYY

Gender *

Male

Female

Prefer not to say

Other:

Full address including postcode *

Email Address *

Do you consent to us sending you emails? *

Yes

Contact number *

If we believe your enquiry would be better suited to a telephone consultation, are you happy for us to contact you via telephone instead of email? *

Yes

Can we send you a text? *

Yes

Can we leave a voicemail? *

Yes

Can we leave a message with someone else at this number? *

Yes

Special Category Data

We need your explicit consent to keep some information known as special category data. This includes things like your ethnicity, religion, health conditions, and sexual orientation. For full details of how we collect and use your data read our privacy policy. https://www.carbs.org.uk/privacy-policy/

Are you happy for us to record your ethnicity if you make it known to us? *

Yes

Are you happy for us to record your Religion if you make it known to us? *

Yes

Are you happy for us to record your Health condition if you make it known to us? *

Yes

Are you happy for us to record your Sexual Orientation if you make it known to us? *

Yes

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