Fill in this form if your home has been adapted to meet the needs of a disabled person living there.
You can visit our disabled person discount page for more information.
If you would like help filling in the form, please contact firstname.lastname@example.org or telephone 01252 398 912.
To complete this form you'll need:
Read about the information you send us and what we use it for in our privacy notice.
If you have a question or comment about one of our services, we'd like to hear from you.
Please visit our getting in touch webpage to give us your feedback or ask a question.
You can fill in this form anonymously, but if you'd like us to get back to you, please provide your contact details.
Read about the information you send to us and what we will use it for.