Adaptations Questionaire

We are currently reviewing our housing stock to ensure we provide the best possible service to our customers. If your property has been subject to adaptations in the past, we need to confirm this to ensure these works are maintained, or replaced as necessary.

The feedback you provide will only be used for the purpose we stated above, and will not be passed onto third parties.

Please provide your contact details below, and responses for questions 2-4. You can then click 'Done' at the foot of the page to submit your responses. We would like to thank you in advance for taking part in this exercise.

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* 1. Your details:

Name

Address

Telephone Number

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* 2. Please tick all of the boxes which are relevant to you, and describe the adaptations which have been completed at your home in the past

Specialist wash facilities in the bath/shower room

Specialist toilet

Specialist bath

Stair lift

Lifting hoists

Through floor lift

Platform lift

Adapted kitchen

Front entrance access ramp

A rear entrance access ramp

Other (Please specify)

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* 3. Do you still require these Adaptations?

Yes

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* 4. Are you happy for us to contact you, if we would like to discuss your responses further?

Yes