Equipment, adaptations and sensory loss referral form

You can use this form to enquire about equipment or home adaptations for yourself or for someone else.

Before you start

To be eligible for help you need to:

  • be 18 years old or over
  • have a disability, illness or injury, sight or hearing loss

Once we've received your enquiry we'll contact you to arrange an assessment.

If your situation is urgent an assessment can be made more quickly. If you're returning home from hospital, or at risk, you'll be given the highest priority.

For information about eligibility and the types of equipment and adaptations available, visit our equipment and adaptations pages.

Start now

How we use your data

We primarily use your data for processing your enquiry. This may be shared with other government departments in accordance with our organisational privacy notice. We never sell your data to third parties or use it to market to you without your consent.