I agree to the Citizens Advice Service recording and using my personal information about me to assist with my enquiry.

 I agree to the Citizens Advice Service sharing my personal information with other advice providers and funders for efficient appointments and referrals to help me with my problems.

Your Details

Name:

Address:

Postcode:

Telephone:

Email Address:

Date of Birth:

Preferred method of contact:

We need your explicit consent to use some information, including your ethnicity, religion, health conditions, sexual orientation and trade union membership. If you agree we will use this information, which is known as special category data to give you advice, gather data to improve our service and support our research in a way that you cannot be identified. We'll make sure all your information is kept safe in our secure case management system.

Ethnicity:

Disability:

 I consent to you using my personal information such as ethnicity and disability

How can we help you?