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Apply for an adaptation

If you feel you need an adaptation to your property due to a disability, please complete the form below and click submit. Please see the adaptations page for more details. 

Our team will contact you to discuss your needs and explain the way forward.

iCM Form
  1. Label
    1. Are You:- *
    2. Does anyone else live with you? *
    3. If YES, please give Name(s), Date(s) of Birth and Relationship(s).
    4. Label

    5. Label

    6. Label

    7. Label

    8. Are any of these people Disabled?
    9. Label

  2. Label
    1. Do you consent to additional information being sought from your GP or any other agency if their advice is considered necessary? *
  3. Do you have trouble walking or moving around? *
  4. Do you use a wheelchair? *
  5. Label
    1. Do you have any support? *
    2. If YES, please tell us what help you get (Tick relevant boxes)
  6. When you have completed the form, please click "Submit". Our Adaptations Team will be notified and will be in contact with you.