Your life. Your plan.
When a service treats you unfairly
Use the prompts that are helpful to you. You can write, draw, or ask someone to record your own words.
You can type your answers below. You can leave any box blank.
Your answers stay in this open browser tab. Clearer does not receive them.
Download your answers to keep a copy. Closing or reloading this page removes the answers from the page.
Choose who you share your completed copy with. On a shared device, clear your answers when you finish.
Your printout may use more than one page. Choose Larger text for bigger writing.
The service I want to use
Write the organisation, place and what you want to do.
The barrier or unfair treatment
Explain what happened, when, who was involved and how disability is connected.
How this affects me
Describe the difficulty, lost opportunity, cost, distress or other effect.
The adjustment I need
Say what would help. Explain why any alternative offered does not work.
My request and the response
Record when you asked, who replied, their reasons and whether anything changed.
My complaint, if needed
Set out the main facts, useful evidence and what you want put right.
Communication and support
Say how you want a reply, who can support you and what information you agree to share.
Actions, dates and advice
Ask who will act and when. Record an adviser’s separate advice on court deadlines; this worksheet is not a claim form.