Citizens Advice in North & West Kent
Advice Enquiry Form

Your Details

Title (optional)
—Please choose an option—MrMrsMissMsDrOther

First Name*

Surname*

Telephone Number* (please note: calls from us may be from a withheld number)

Email*

Date of Birth*

Address*

Post Code*

Have you contacted us before?*
YesNoUnsure

Do you have difficulties communicating in English?*
YesNo

If you have difficulties communicating in English, what language do you prefer to communicate in? (optional)

How would you describe your ethnicity?*
—Please choose an option—White - British, English, Welsh, Scottish or Northern IrishWhite - IrishWhite - Gypsy or Irish TravellerWhite - OtherMixed - White and Black CaribbeanMixed - White and Black AfricanMixed - White and AsianMixed - OtherAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - OtherBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British - OtherArabRomaPrefer not to sayOther

How would you describe your gender identity?*
—Please choose an option—ManWomanNon-binary, gender fluid or gender queerPrefer a different termPrefer not to say

Do you consider yourself to have a disability or long term health condition?*
Yes - disabledYes - long term health conditionNoPrefer not to say

Your Enquiry

What is your enquiry about?*
BenefitsMoney and DebtHousingFamily & RelationshipsImmigrationWorkEnergyConsumerOther

Tell us more about what you need advice on.* Please try to give us as much detail as possible so we can give you the best advice.

Have you got any deadlines (threatened action / reply by dates)?*

What have you done so far?*

What would you like us to do for you?*

Permissions

Let us know the best way to contact you about your enquiry. Please give us permission to contact you in as many ways as possible, as this will make it easier to give you advice.

Please select if you are happy for us to:
Send you an emailCall you on the phoneLeave a voicemailSend a text message

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