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Contact Us: Older People’s Services
If you would like more information about referring yourself or someone else to our Older People's Services, please complete this form. Should you wish to get in touch with Community Integrated Care for any other reason, please visit our contact pages.
First Name
*
Last Name
Phone No
Email
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Preferred Communication Method(s)
Email
Phone
SMS
Postal Mail
Are you enquiring on behalf of yourself or someone else?
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Myself
Someone else
What is your relationship with that person?
What is their age (if known)?
What region are you based in?
North West
North East
Midlands
South West
South East
Scotland
Wales
In what area (town/city) do you require support?
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Please tell us about your current situation and the support you are interested in
*
Please tell us about their situation and the support they are interested in
*
Are there any specific health needs relevant to their care?
*
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