Environmental health housing enquiry form

Enquirer details

Source

Tenant Owner/Occupier HW Fire Neighbour Landlord Agent Councillor Other

Other details

Title

Mr Mrs Miss Ms Other

Other details

First name

Last name

House/Flat name or number

Street

Town

County

Postcode

Telephone number

Mobile number

Email address

Details of enquiry

For example, threatened eviction, housing hazards, unlicensed house in multiple occupation (HMO)

Have you contacted your landlord?

Yes
No

If no, why not?