Consultation and Involvement Questionnaire














Single elderly person (aged 75+)  Elderly couple (at least one aged 75+)
Single elderly person (aged 60+)  Elderly couple (at least one aged 60+)
Single adult (aged 16-59)  Couple (both aged 16-59)
Single person with at least one
child under 16
 Couple with at least one
 child under 16
Other (please specify)  Are any member of Household Disabled?
   



  You   Partner   You   Partner
British     African  
European     Caribbean  
Pakistani     Of mixed ethnic origin  
Bangladeshi     Other (please specify)  
Indian    



Allocations / Lettings     Facilities for the Elderly  
Customer Care     Clean and Tidy Environment  
Rents / Charges / Rent Arrears     Tenancy Conditions  
Repairs / Major Works     Equality & Diversity  
Community Safety     Other (please state)  
Facilities for Young People    
Facilities for Disabled    



Large Print     Translation to other language (please specify)  
Disabled Access    
Child Care     Other (please state)  



Large Print     One to One Interview  
Questionnaire     Tenants and Residents Group  
Focus Group     Newsletters/leaflets  
Telephone Survey     Text Message  
Meeting     Other (please detail)  
Email    


Morning     Afternoon   Evening  




YOU WILL RECEIVE AN AUTOMATED ACKNOWLEDGEMENT FOR YOUR QUERY AND YOU CAN EXPECT A FULL RESPONSE WITH 10 WORKING DAYS OF RECEIPT.