Applying for a Community Alarm

Contact Details
  1. Is the alarm for you ? *
       
Personal Details
  1. Is there a history of falls? *
       
  2. Is there any memory loss? *
       
  3. Is there any hearing or sight problems? *
       
Thinking about the person who the alarm is for, please can you provide the following information
  1. / /
  2. Do they receive any of the following means tested benefits ?


  3. Do you they have a Chronic Illness or Disability
       
  4. Will they have any local Key Holders
       

Privacy Notice
We collect and use information about you so that we can provide you with council services. Full details about how we use this data and the rights you have around this can be found at www.milton-keynes.gov.uk/privacy. If you have any data protection queries, please contact the Data Protection Officer at data.protection@milton-keynes.gov.uk