Name:
Address:
email
Telephone:
Area of issue:
Baby changing facilities
Churches
Dentist
Doctor's surgery
Hospital
Offices
Other
Other public buildings
Public toilets
Pubs and bars
Restaurants
Schools and Colleges
Shopping centres
Supermarkets
Theatres
Village and Town halls
Description of issue:
Rating:
Very poor
Poor
Acceptable
Good
Very good
Stafford and District Access Group - Survey Form