Council Forms

Equipment and adaptations referral

Personal details

Details of person requiring assistance.

Title
Address Address
Marital status
Do you live alone?

Equality monitoring

Equality monitoring is a way of checking whether the service is performing well for everyone. We'd appreciate it if you could take the time to provide the following information about yourself. This will improve our knowledge about users of our services and help identify areas for improvement. Your answers will be treated in the strictest confidence. All data disclosed will comply with the Data Protection Act 2018 and UK General Data Protection Regulation. You do not have to answer these questions, and it will make no difference to the way the council treats you whether you answer them or not.

Gender
Ethnicity
Sexual orientation
Religion