Apply for Technology Enabled Care (Telecare)

Please be advised the London Borough of Hillingdon supplies a digital base unit and pendant as standard as part of the telecare service - additional equipment may require a further assessment.
About you
1. Is someone helping you to complete this form?*
  
  Yes
  
  No
2. Please be aware that applicants under 75 may be subject to a charge which will be confirmed after submission of the application.
3. 1. Let us know about the person helping you
  2. Name of person helping
  3. Their relationship to you
  4. Please specify their role
  5. Do you have a recommendation/justification for additional equipment needs?
  6. Has the applicant been advised of possible charges (if under 75)
    
    Yes
    
    No
    
    N/A over 75
  7. Name of organisation
  8. Their email address
  9. Their telephone number
4. 1. Do you have communication difficulties?
    
    Yes
    
    No
  2. Do you have any difficulties with understanding and/or retaining information?
    
    Yes
    
    No
  3. Do you have any difficulties making decisions and/or understanding their impact?
    
    Yes
    
    No
  4. Your answers indicate that you are completing this form by yourself and that you have difficulties with communicating, understanding information and/or making decisions.
    
    As a result, we think that you might benefit from support to help you complete the screening tool.
    
    Call us on 01895 556633 to discuss your needs.