Adaptations enquiry form

Sometimes it only takes small changes to help you continue living independently when life gets more challenging. There are lots of ways in which we can help.

Fill out this form to tell us what home adaptations you think you need. We will review your application and get back to you as soon as we can.

If the changes are outside the scope of what Futures can do to help, we can also put you in touch with other organisations such as your local council that can help.

Who is the aids or adaptations request for? *

What type of aid or adaptation do you need? *

Where in the property are these aids or adaptations needed *

Where do you need lever taps installing?

Where do you need a key safe fitting?

Do you have another aids or adaptation request? *

What other aid or adaptation do you need? *

Where in the property is this second aid or adaptation needed? *

Is there any more information about this second aid or adaptation you would like to share with us?

Where do these additional lever taps need fitting? *

Where does this additional key safe need fitting? *

Your first name *

Your last name *

What is the address of the property where these aids or adaptations are needed *

Your contact telephone number *

Your email address

Is there any extra information about this request that you think we need to know?

If you have photographs or documents that will help to explain the aids and adaptations you need, please upload them here.

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Security check *

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Home adaptations enquiry form

If you need changes to your home to help you live independently you can let us know here.