Telecare services request form

Telecare self-check toolYou can use this form to apply for Telecare services, for yourself or someone you look after.

Before you apply, if you have not already done so, you may find it useful to use the Telecare self-check tool, which asks you some questions about you and your needs, then provides Telecare specific and general advice based on your answers (there is no need to enter any personal data)


1 Start 2 Page 2 3 Page 3 4 Page 4 5 Complete

You can use this form to request Telecare services, which include alarms and sensors for your home.

There is a charge of £5.75 a week for Telecare services.

Once you have submitted your request, a member of the team will get in touch with you to arrange the right services for your needs.

Correspondence / contact details (if different from customer details)
Personal details
Please give us the phone number you would like us to use to contact you
Some telephone suppliers may not guarantee to support Telecare sytems. If your supplier is not BT, please check with your supplier that they do support Telecare systems