Health - Vitality - Wellbeing

Feedback

Please tell us what you think

Everything we do at Fusion is informed by our customer's needs now and in the future. By receiving your feedback, we have the opportunity to address what is important to you, be that developing new services you would value or where necessary improving upon what we currently offer or the way we deliver it. Please let us have your feedback by completing the form below.

Fields marked with * are required to complete the form.

How do you score us on the following?

	excellent	good	satisfactory	poor
Knowledgeable, friendly staff
Range of activities & services
Condition of building
Cleanliness
Value for money
Equipment
Ease of booking and paying
Ease of gaining information
Web site

Your Visit

Activity *
Centre visited *
Date of this visit *	Year Month Day
Time of this visit

About you

Gender	Male Female
Age	16-19 20-28 29-34 35-49 50-59 60+
Name *
Membership number
Address
Town
Post code *
Daytime Tel.
Evening Tel.
Mobile *
Email address *
Do you consider yourself to have a disability in accordance with the Disability Discrimination Act?	Yes No

What is your ethnic group?

Please choose ONE section, then tick the appropriate box. The breakdown of ethnic groups has been taken from the recommended British census categories.

White	Mixed	Asian or Asian British	Black or Black British	Chinese or other
British	White & Black Caribbean	Indian	Caribbean	Chinese
Irish	White & Black African	Pakistani	African	Other background
Other White background	White & Asian	Bangladeshi	Other Black background
	Other Mixed background	Other Asian background

Your Comments

Is your comment a	Complaint Suggestion Compliment
Your comments
	Please tick here if you do not wish to receive details (via e mail or SMS) of our special offers or service updates that may be of interest to you. We do not pass on personal details to any third party.