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1
What is the Babington centre for your feedback?
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Enter NA if no centres apply.
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2
Please enter your feedback below with as much detail as possible.
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Your submission will be treated with the strictest of confidence. Only Head Office management will be able to see your response below.
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3
Would you like to give us your contact details so we can follow up?
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If you do not give us your contact details, then we will not be contacting you to follow up on your complaint.
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4
What is your name?
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5
What is your child's name?
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6
Phone Number
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Please enter a valid phone number.
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7
Email
example@example.com
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