Feedback form

Please give as much of the following information as possible. Thank you.

If you would like to send your feedback in writing, then please download our feedback form to print out.

Your details

Title (Mr/Mrs etc)

First name

Surname

Your address

Postcode

Email address

Daytime phone number

Evening phone number

Section one

What do you think Epilepsy Action did well or did wrong/failed to do?

How have you been affected by these actions?

What do you think Epilepsy Action should do to improve further on this issue?

If you are making a helpful comment or compliment, please go to section three.
If you are making a complaint, please help us by completing sections two and three.

Section two

On what date did you first find out about the matter you are complaining about?

Have you complained about this matter before?

If so, a. when did you first complain about it?

b. was your complaint in writing?

c. have you received a written reply?

If more than 3 months have passed since the incident, please tell us why you've not complained before?

Section three

If you have any other information that will be helpful, please enter it in this box:

The information you give to Epilepsy Action may be used to help the charity, particularly in improving its services or meeting its statutory obligations. Your personal information will only be used when necessary to help us investigate a complaint.

Epilepsy Action privacy policy

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