Title * Please select Mr Mrs Miss Ms Dr Other First Name * Surname * Address 1 * Address 2 Town * Postcode * Contact Telephone Number * Email Why are you contacting us? * Please select Getting involved Training General enquiry Complaint Feedback Additional Comments Select a category * Please select Pest control Pets Parking Keys/key fobs Mutual exchange Housing transfers Housing waiting list Right to buy Right to acquire Staircasing Changes to tenancy Other Please provide as many details as you can * When did this problem first start occurring? * When did this problem first start occurring? shadow Please provide us details about your complaint * How have these problems affected you or your family? * How would you like us to resolve your complaint? * Are there any vulnerable family members in your household? (tick all that apply) No vulnerability Elderly resident over 70 Elderly resident over 80 Young children under 3 months Young children under 12 months Serious medical condition Mental health disability Physical disability What is your desired outcome? * Please select Apology Provide a service Policy change Compensation Which opportunity are you interested in? Please select Community Champions Focus Groups Local Panels Mystery Shopping Resident Associations Resident Groups Readers Group Resident Quality Inspectors (RQIs) Scrutiny Panel Surveys Young Ambassadors Do you have any suggestions for other opportunities that you would like to see? Would you like us to contact you about this? Yes No How can we help you? Getting into work Training Support and advice Book onto a workshop/course Which workshop/course would you like to book onto? * Do you want us to contact you? Yes No Need to send a picture of your repair or other image? Upload it here Please do not include any photos of people
