Service Request Form

Use this form to make a complaint about either an item of food or a food business / premises.

Please ensure that you have read our information on making a complaint before you complete this form.

Use your computer's mouse or the [TAB] key to move between fields. Do not use [ENTER] in the single line entries or the form may be sent prematurely.

About You

Your Name:

Your Address:

Daytime Telephone:

Evening Telephone:

Your E-mail address:

If you do not have an email address please leave the "Your E-mail address" box blank.

Which of these best describes your ethnic origin:

Bangladeshi	Indian
Black African	Irish
Black Caribbean	Pakistani
Chinese	White
Other (please state)

About Your Complaint

Is this complaint about:
An item of food, or
A food business / premises

Name of business or premises:

Where purchased / address of premises:

Describe the nature of your complaint:

If you are complaining about a specific item of food please continue, otherwise go straight to the bottom of the form and send it to us by using the 'submit' button.

Description of food:

Date and time of purchase:

Date and time of discovering the problem?

How was the food stored between purchase and discovery?

How have you stored the food since discovery?

Do you still have the food?

Do you still have the packaging?

Do you still have the receipt?

When you have completed the form, please click to send it to us.

A member of our Food Safety Team will then contact you in the near future.

Please check your contact details to ensure that we are able to contact you.