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Find a home
Find a home
Housing Register
Homelessness
Mutual exchange
Saxon Court
Other housing options
Your home
Your home
Your tenancy
Rent and payments
Day-to-day Repairs
Damp, Mould and Condensation
Safety in your home
Major Improvement Works
High rises
Safety information about your high rise building
Building Safety Agreements
Leaseholders
Customer Engagement
Buy a home
Estates and environment
Home Contents Insurance
Leaflets
Advice and support
Advice and support
Cost of Living
Domestic Abuse
Domestic Abuse Support
Money advice
Antisocial behaviour (ASB)
Safeguarding
Solihull Independent Living Service (SILS)
Squatters and subletting
Your right to an advocate
About us
About us
Work with us
Service Standards
Policies and procedures
Our responsibilities
Responsible Persons
News
Latest News
Newsletter
Board
Delivery Plan & Future Strategic Vision
Executive Leadership Team
Performance
Information Governance
How we spend our money
Social Housing Regulation
Equality and Diversity
Contact us
How can we help?
Complaints
Compliments
Social media
Contact centre
Media enquiries
Our offices
Halls for hire
My SCH Account
My Account
Search…
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This referral form is for customer who would like more information on the Assistive technology available- This is not a full referral
REFERRER DETAILS
Are you making a referral on someone's behalf or for yourself?
*
For myself
On behalf of someone
Referrer name
*
First
Last
Referrer Phone
*
Referrer Email
*
Relationship to customer
*
CUSTOMER DETAILS
Customer Name
*
First
Last
Customer Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Customer Phone
*
Customers contact number, not a relatives etc
Customer Email
Customer Date of Birth
*
WHAT WOULD YOU LIKE TO HEAR ABOUT?
What service level are you interested in?
*
Safe and Sound- Monitor and responder
Safe and Sound Lite- Monitor only
I have not decided yet
What piece of equipment are you interested in? More than one can be selected
*
Pendant only
Falls detector
Smoke detector
Door exit alarm
Medication dispenser
Chair/bed occupancy sensor
Pressure mat
Flood detector
Heat detector
Extreme temperature sensor
Motion sensor
Epliepsy sensor(for use in bed only)
Voice alarm
Ping pong switch
Blow switch
i am unsure yet
HOW TO RECEIVE THE INFORMATION
How would you like to receive the information?
*
Email
Post
Just a phone call to discuss
Shall we send the information to the address/email/phone that is already provided for the customer?
*
Yes
No- please take different details
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
GDPR
Would you like a copy of this email sent to you for your own records?
*
Yes
No
GDPR Statement - The information you provide will be used to assist us in understanding your enquiry. We may also use it to communicate with you and provide the services you need or are entitled to receive and to monitor our performance in providing services to you; to gather statistical information to allow us to plan future provision of services and to obtain your opinion about our services. We may share data with other council services & partner organisations to ensure records are kept accurate and to identify services or benefits you may be entitled to or interested in. It is therefore very important that you notify us if any of the information you have provided changes at any time. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. If you would like to learn more about how Solihull Community Housing uses personal data please refer to our Privacy Notice on the website.
Submit (click ONCE)