Customer Care Feedback Form

Please note: Web4residents is a purely news and information portal, for the convenience and use of our residents as an on-line version of "The Communicator" the regular newsletter we produce for our residents.

Web4residents, does not have access to, or contain, any personal information or details regarding any of our residents.

	This is your chance to let us know what you think about the services we provide. Complete and return this feedback form to our Customer Feedback Officer and, if you are a Swan STARCARD owner, you will be entered for a prize draw to have £50 credited to your StarCard.
	About you You do not have to give your details, but without them we will not be able to enter you in the Prize Draw
Your full name	Please enter your name
Title (Mr Mrs etc.,)	Please enter your title (i.e. Mr Mrs, Ms)	Please enter your title (i.e. Mr Mrs, Ms)
Your address	Please enter your address
County/Area	Please enter which area/county you live in	(i.e. Tower Hamlets, Essex)
Your Post Code	please enter your post code
Phone Number	Invalid Input	Your daytime phone number
Alternate phone number	Invalid Input	evening or alternate number we may contact you on
E-Mail address	Please enter a valid email address
	About your contact with Swan
Date	Invalid Input	The date you contacted us
What did you contact us about?	Rent/Service charge Welfare Benefit Advice Anti-Social Behaviour Estate Services Repairs and Maintenance Regeneration Resident Involvement Other Please select one of the dates
Please specify	Invalid Input
How easy was it to contact staff?	Very EasyFairly EasyFairly DifficultVery Difficult Invalid Input
Were the satff helpful?	AlwaysUsuallyOccasionallyNever Invalid Input
Were the staff courteous?	AlwaysUsuallyOccasionallyNever Invalid Input
Were the staff knowledgeable?	AlwaysUsuallyOccasionallyNever Invalid Input
What was the agreed outcome or promise of your enquiry	No promise made (query answered) Promised to ring back Promised someone else would ring back Promised to send information Promised to pass information on Other (please record in feedback comments area below) Invalid Input
Did staff keep their promise and/or deliver the promised outcome?	YesNoStill ongoing Invalid Input

Were they able to deal with your problem?	YesNoStill ongoing Invalid Input

Your feedback comments
Which member of staff did you contact?	Neighbourhood/Housing Officer Income Officer Caretaker Surveyor Repairs Call Centre- Axis Receptionist Manager Other Invalid Input
Please specify	Invalid Input
If you know your contacts name, please let us know	Please enter your name

Overall, how satisfied are you with the Swan services?	Very Satisfied Fairly Satisfied Neither satisfied or dissatisfied Fairly dissatisfied Very dissatisfied Invalid Input

	Equality Monitoring (optional) We try to make sure that we give equal access to anyone wanting to give us feedback about our services. We monitor all feedback to see what is happening. By answering the following questions, you will help us to do this.
Are you a disabled person?	YesNo Invalid Input
If yes - how would you describe your disability?	I have a hearing impairment I have a speech/language impairment I have a mobility impairment I have a visual impairment I have a learning disability I am a wheelchair user I have a mental health condition I have a long standing illness or condition eg cancer, diabetes, epilepsy I am dyslexic Other Invalid Input
Other disability details	Invalid Input
What is your age (in years)	Invalid Input
What is your gender?	MaleFemaleTransgender Invalid Input
What is your sexual orientation?	Invalid Input
	What is your ethnic group?
White	Invalid Input
Mixed	Invalid Input
Asian or Asian British	Invalid Input
Black or black British	Invalid Input
Other ethnic group	Invalid Input
Other ethnic group details	Invalid Input
What is your religion?	Invalid Input
Please specify	Invalid Input
Spam Guard *()** Please enter the words you see in the box, in order and separated by a space.	Please try again

	Data Protection act 1998 Any personal information you provide to us will be processed fairly and lawfully, and no information from any of our forms is retained on this website. For further information regarding the Data Protection Act please go to http://www.opsi.gov.uk.

This is your chance to let us know what you think about the services we provide.Complete and return this feedback form to our Customer Feedback Officer and, if you are a Swan STARCARD owner, you will be entered for a prize draw to have £50 credited to your StarCard.

About you

Equality Monitoring (optional)

Informing You

Involvement

This is your chance to let us know what you think about the services we provide.

Complete and return this feedback form to our Customer Feedback Officer and, if you are a Swan STARCARD owner, you will be entered for a prize draw to have £50 credited to your StarCard.