Please complete the following information to help us maintain contact and ensure appropriate support during the ongoing landslip response.
Full name
Maximum 255 characters
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Email address (for further updates)
Address (House number, street)
Postcode
Telephone Number (mobile preferred)
How many live at this property - in addition to yourself? (number)
Does anyone in the household have a vulnerability or health need? (Eg: mobility issues, chronic illness, mental health needs, pregnancy, communication needs)
If YES to the above question, please provide detail below...
Is anyone receiving care or support from ABUHB or another Local Health Board or private care provider?
IF YES to the above question, please provide brief details below...
Maximum 20,000 characters
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Do you give permission for us to share this information with emergency services and relevant Health Boards?
Do you consent to us contacting you directly with updates?
Do you acknowledge that updates will also be available on our official web pages? Details found here: www.monmouthshire.gov.uk/r1-cwmyoy-landslip
Do you run a local business from this address
Please use this box below for, any additional information you feel we should know
