Concerns & Complaint form - Cadwyn Housing Association

Fields marked with an * are required

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SECTION A: Your details

Surname:

Forenames(s):

Title: Mr/Mrs/Miss/Ms/ if other please state

Address

Postcode:

Your email address:

Daytime contact phone number:

Please state how you would prefer us to contact you:

Are there any requirements or vulnerabilities we should be aware of when dealing with your complaint?

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SECTION B: Making a complaint on behalf of someone else: Their details:

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Their name in full:

Address and postcode:

What is your relationship to them?

Why are you making a complaint on their behalf?

Are there any requirements or vulnerabilities we should be aware of when dealing with this complaint?

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SECTION C: About your concern/complaint

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Name of the department/section/service you are complaining about:

What do you think they did wrong, or failed to do?

Describe how you personally have suffered or have been affected:

What do you think should be done to put things right?

When did you first become aware of the problem?

Have you already put your concern to the frontline staff responsible for delivering the service? If so, please give brief details of how and when you did so:

If it is more than six months since you first became aware of the problem, please say why you have not complained before now:

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Date *

Signature:

I consent to this data being stored and used for contact & administration purposes as explained in the form by Cadwyn *