One Number, One Solution, One Vision 0845 140 1234
Investment Programme
Find out what work you can expect to your home and when it is scheduled to start
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Customer Profile Survey
Information about you
Name
Address
Gender
Male Female
Date of Birth DD/MM/YYYY
Work Number
Home Number
Mobile Number
Email Address
     
Access to services Yes If yes, please give details
Does anyone in your household have a disability or any health issues?
Hearing difficulty
Speech difficulty
Visually impaired
Physically impaired
Mental health issues
Learning disability
Does anyone in your household have difficulty in accessing services due to their disability and/or health issues?
Yes No
   
What best describes your ethnic group?
White British Mixed - White and Black Caribbean
White Irish Mixed - White and Black African
White Other* Mixed - White and Asian
Asian/Asian British - Indian Mixed - Other*
Asian/Asian British - Pakistani Chinese
Asian/Asian British - Bangladeshi Gypsy
Asian/Asian British - Other* Traveller
Black/Black British - Caribbean Other*
Black/Black British - African Prefer not to say
Black/Black British - Other*  
*please describe:
   
Can you tell us what your religion or faith is?
No Religion Jain
Bahai Jewish
Buddhist Muslim
Christian Sikh
Hindu Prefer not to say
Other, please describe:
   
What would best describe your sexual orientation?
Bisexual Heterosexual
Gay Man Prefer not to say
Gay Woman / Lesbian  
Other, please describe:
   
Getting Involved  
Would you be interested in being contacted relating to any of the following? (please tick all boxes that apply)
Getting involved in a Residents Association
OVH Customer Panel
Discussion of focus groups with other residents
Attending One Vision Housing meetings or events
Taking part in neighbourhood walkabouts with One Vision Housing staff
Becoming a member of the Tenant Approval Panel - being sent information to read and comment upon
Participating in a telephone survey
Participating in a postal survey
Participating in an email survey
Participating in a face to face survey
 
Contacting You
Is English your first language? Yes No* *If no, what is your first language?
 
Do you need to receive information in any of the following formats? (tick only one)
Large Print Audio Tape
Braille In your Language
CD  
 
Would you prefer to receive written information via the following? (tick only one)
Posted Letter Email
 
When contacting you via telephone, would you like us to use the folling? (tick all that apply)
Type talk Text messages
 
How do you prefer us to contact you? (tick only one)
Telephone Post Email Text Home Visit
 
Contacting Us
How do you prefer to contact One Vision Housing?
Telephone Post Email Text Internet
In person Other*
*Please state
 
One Vision Housing are data controllers under the Data Protection Act 1998. We will process personal information you have supplied to us in accordance with that Act and only for the purpose for which it is collected.  Data will not be disclosed to any unauthorised persons.