CONCERNED ABOUT FLOODING?

Please answer questions below to send the referral form to your local authority. The local authority will contact you within 2 to 5 days to make an appointment.

Do you have difficulties turning off taps?
Yes No
Do you need assistance while in the bath?
Yes No
Do you use a shower?
Yes No
Have you left a tap running by mistake?
Yes No
Does your bath overflow?
Yes No
If your sink gets blocked, do you know how to unblock it?
Yes No
Do you receive any homecare?
Yes No
Are you seeing an Occupational Therapist or Another Service?
Yes No
Are you concerned about any other risks?
Yes No