Questionnaire

The brief questionnaire below has been sent to all of the families who have so far contacted us. If you wish to make a contribution to the Inquiry whether by providing us with information, making a written statement or attending to give evidence, please complete your details below.

If more than one person in your household or family wishes to make a contribution, please ensure that their details are entered at the bottom of the form or on a separate form. Please press submit to send the questionnaire to the Alexander Harris Inquiry Team. A member of the Team will then be in contact with you.

If you have any questions with regard to the Inquiry or the Inquests then please address your queries to the Shipman Inquiry Team at Alexander Harris.

Document Format.

Questionnaire

 

Personal Information

Title
First Name
Last Name
Address
Address Line 2
Town
County
Postcode
Telephone
Email
Date of Birth: Day: Month: January February March April May June July August September October November December Year:

Contribution

	I wish to make a contribution to the Public Inquiry
	I wish to provide information to the legal team representing the families
	I would like someone to visit me to assist me in making a statement

Details

 

Please type here brief details as to why you would like to make a statement to the Public Inquiry and/or have information which you would like to provide to the Inquiry Team

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