Please complete the following information to help us maintain contact and ensure appropriate support during the ongoing landslip response.
Full name *
Maximum 255 characters
0/255
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
0/20,000
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
