Contact us about Telecare today

Telecare Enquiry

If you would like more information or to apply for Home Safety Service Telecare, please complete the form below and one of the TEC team will get back to you.

1. Are you applying for yourself or someone else?
2. *
3. 1. Please Provide:
  2. Your name
  3. Your contact telephone number
  4. Your relationship to the applicant
5. Applicant Details
6. Name*
7. Date of Birth (DD/MM/YYYY)*
9. Address
10. Your address
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  3. Your Address
    
    OSG Postcode Search (Custom drop-down list)
    
    Postcode
    
    Address
12. Telephone
13. Landline Telephone Number*
14. Mobile Telephone Number
16. Reason For Enquiry
17. Is this equipment to help with end of life care?*
  
  Yes
  
  No
18. Have you fallen in the last 12 months?*
  
  Yes
  
  No
19. If you answered "Yes" what was the outcome? (e.g hospitalisation)
20. Other (Please Specify)
22. Keyholder Details
23. We require contact details of at least one key holder. A key holder may be contacted at any time of the day or night by Careline to assist in an emergency or to relay important information regarding welfare or whereabouts.
  
  Keyholders may be family members, neighbours or friends and should ideally be able to attend (if required) within a recommended 45 minute maximum response time. Keyholder’s may be called at the service users request or if there is any alert from a Telecare sensor and you do not confirm all is well.
24. Do you have a family member/friend/neighbour who can act as a keyholder?*
  
  Yes
  
  No
25. 1. Please provide their:
  2. Name
  3. Your address
    
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    Your Address
    
    OSG Postcode Search (Custom drop-down list)
    
    Postcode
    
    Address
  4. Contact Telephone Number
26. Your application can not proceed at this stage without one keyholder, please telephone Home Safety Service to discuss this and seek further advice on 01506 284440 (option 1).

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Contact us about Telecare today

Telecare Enquiry

Are you applying for yourself or someone else?

Applicant Details

Address

Telephone

Reason For Enquiry

Keyholder Details