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General Satisfaction
Tell us about your experience
Have you been in contact with the Housing Assets Team within the last 12 months?
Yes
No
When did you last contact us
For what reason did you contact us?
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Housing Repair
Estate Works
Heating issue
Tenant Improvement
Other
How helpful did you find the staff you dealt with?
Excellent
Good
Average
Poor
Very poor
How courteous did you find the staff you dealt with?
Excellent
Good
Average
Poor
Very poor
How knowledgeable did you find the staff you dealt with?
Excellent
Good
Average
Poor
Very poor
Do you have any other comments?
Do you feel that your needs were met?
Yes
No
If your needs were not met please indicate why below
How would you rate your overall experience?
Excellent
Good
Average
Poor
Very poor
Would you like to be sent information on how to make a complaint?
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No
Would you be happy to be contacted by us to discuss the issues you have raised?
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No
How would you like us to contact you?
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Telephone
Email
Letter
(Please provide your contact details below)
Where is your nearest Local Housing Office?
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Abbey Hulton
Bentilee
Blurton
Burslem
Chell Heath
Hanley (Smithfield 1)
Longton
Meir
Stoke (Civic Offices)
Tunstall
Your Contact Details
Name
First
Last
Email
Telephone
Are you willing to provide us with some additional monitoring information?
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Please note: Monitoring information helps us identify trends and gaps in our information gathering, enabling us to provide more detailed evidence to management and service providers about services we provide with the aim of improving.
Monitoring Information (optional)
Gender
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Male
Female
Transgender / gender reassignment
Prefer not to say
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Age range
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Under 18
18 - 25
26 - 35
36 - 45
46 - 55
56 - 65
66 - 75
75 +
Unknown
Martial status
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Civil partnership
Co-habiting
Divorced
Living with partner
Married
Separated
Single
Widowed
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Unknown
Do you have a disability?
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Yes
No
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Unknown
Ethnic origin
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Asian - Bangladeshi
Asian - Indian
Asian - Pakistani
Asian - Other
Black - African
Black - Carribean
Black - Other
Chinese
Mixed - White/Asian
Mixed - White/Black African
Mixed - White/Black Carribean
Mixed - Other
White - British
White - Irish
White - Other
Other
Prefer not to say
Unknown
Religion
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No religion
Christian (all denominations)
Buddhist
Hindu
Jewish
Muslim
Sikh
Any other religion
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Unknown
Sexuality
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Heterosexual
Gay man
Gay woman
Bisexual
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Unknown
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