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Adult Social Care enquiry form

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Please complete all fields marked *. Hover your mouse over anyExample of help marks for additional help.
Before you fill in this form, you may find the advice or information you are looking for on these pages:

Staying independent - advice and support on equipment and services that can help you to stay living at home

Care and support for adults - including information for adults with learning disabilities, mental health problems, physical or sensory disabilities and how to register your disability with us

Other useful information: Carers, Blue Badge Scheme - including online application form

Your Details

 
Who are you enquiring for?
Are you enquiring on behalf of someone else? *
If Yes, then who are you enquiring for ? (these fields are then compulsory)
Does the person you are seeking information for know that you are enquiring on their behalf?
About your enquiry or request
In order that we can ensure the correct team contacts you, please select the option or options that best describe your request (please select all that apply):  *

 

 
In the first instance, we need to contact you by phone to discuss your enquiry - is this okay? *

 

 
How would you like us to reply? *

 
If you have completed all the fields marked *, then please click "Submit".

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