Aids and Adaptations Form

Personal Details

Full Name

Address

Address Line 1

Address Line 2

Town

County

Postcode

Tenancy Reference Number

When did you move into the property?

Who in the household needs this aid or adaptation?

Have you contacted the Social Care Department, Occupational Therapist or GP?

Yes

If yes, can provide the name if the OT or GP?

Which Aids & Adaptations are you requesting? Where are they required?

Why do you feel you need them?

Is there any other information you would like to give?

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Privacy

By uploading your information to apply for this job you are agreeing to us using and storing your personal data for the purposes of the recruitment you have expressed an interest in. For further information of Castles & Coasts Housing Association privacy policy please access the following webpage http://castlesandcoasts.co.uk/privacy/.

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Last Name *

Email Address *

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