Independent Living Advisory Service Application Form

Please complete the form below or alternatively, you can download the form here

If you need help completing this form or for a copy to be sent to you in the post, please contact Toni on 020 8371 6611 ext 620.

In general, we do not accept applications for hospital discharge or from clients who have dementia.  Our primary criteria is that you live in your own home and struggle with physical health or vision impairment. Please contact us to discuss this further as we will review on a case-by-case basis.

We take our obligations to data protection very seriously. The personal data you share with us will be handled strictly in accordance with our privacy notice and UK data protection law.