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Your Comments

You can use this form to make a complaint, compliment or suggestion.

Please click here if you have not contacted us before and would like to report a problem.

If you would like a personal reply, please provide the following details.

YOUR DETAILS

Surname
First name
House / flat number
Road / Court
Area
Postcode

CONTACT DETAILS

Daytime telephone number (if none, put none)
Email address (if you want us to contact you this way)

Please provide us with details of your complaint, compliment or suggestion. 

This is a

Please Select... Complaint Compliment Suggestion

What service are would you like to comment on?    

Please Select... Antisocial behaviour Rent collection and arrears recovery Your tenancy Your estate Customer services Repairs and maintenance Major work to your home Leaseholder and Right to Buy service Other Don't Know

Please provide us with as much information as possible such as what, where and who?     


If you are making a complaint, what action do you think should be taken to resolve it? 

Confidential monitoring

You do not need to fill in this part of the form.

We ask for this information to make sure we provide a fair and equal service to all our customer.

Your age

Do you consider yourself to be disabled?    

Please Select... Yes No

Which religion or belief any do you follow?    

Please Select... Buddhism Christianity Hinduism Islam Judaism Sikhism Other No religion / belief

If English is not your main language, which language would you like us to

Speak to you in ?
Write to you in ?

What is your ethnicity?    

		Please Select... British Irish Caribbean Traveller African Gypsy Indian Pakistani Bangladeshi Chinese White and black Caribbean White and black African White and Asian Other black background Other white background Other ethnic group Other Asian background Other mixed background
If you selected ‘any other’ please state

Is there anyone who relies on you for care and attention?   

Please Select... I look after children I help an adult with their daily routine

What is your sexual orientation?

Please Select... Bisexual Gay man Gay woman / lesbian Heterosexual / straight Other Prefer not to say

Data Protection

The information you supply on this form will be sent to Six Town Housing. It will only be used to process your request for information or services described on this page.

Any details you supply will be treated as confidential and will only be used in direct relation to work needed to carry out your request.



   

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