Contact

    Complete our form and a member of our team will be in touch

    Your details

    Date of birth

    For example, 01 08 1997

    We use this to help link you to local services in your area


    Are you registered at a South Gloucestershire GP surgery and over 18?


    Which of the following topics are you interested
    in?

    Tick all that apply


    What is the most important topic to you?

    Tick all that apply

    Type what you would like to enquire about

    How would you like us to contact you about your enquiry?


    or

    About you

    The information you provide enables us to check that we give a good and fair service to everyone and identify
    how we could potentially improve our services to you in the future.

    All your answers will be treated in the strictest confidence and will only be used to monitor and help
    improve our services.

    You can read more about our monitoring in our privacy policy.

    Equalities monitoring

    What is your ethnic group?

    Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani


    or

    Includes any Black background


    or

    Includes any Mixed background



    or

    Includes any White background



    or

    Includes any other ethnic group

    or

    Equalities monitoring

    What is your sexual orientation?

    or

    Equalities monitoring

    Are you a carer for someone?

    or

    Equalities monitoring

    What is your current employment status?

    or

    Equalities monitoring

    What is your religion?

    or

    Equalities monitoring

    Do you have a disability?

    This could be a physical or sensory impairment, mental health condition, learning disability or
    difficulty, long standing illness or health condition.



    or

    How did you hear about us?
    Other

    Submit your enquiry

    Your information will be used to provide the service and will only be shared with our partners (see our partners ) involved with delivering One You South Gloucestershire in accordance with the South
    Gloucestershire Council privacy notice You may tell us at any time if you would
    like to stop the service or update your details.

    Do you give consent for your information to be used by One You South Gloucestershire as stated above?

    As you do not give consent for us to receive and use your data, please call us on 01454 865337 so we can help you with your query