Care Request

Please complete the request form below, we will respond to your enquiry as soon as possible.

The below section is about you, the enquirer

Your name (required)

Your postal address

Your postcode

Your contact telephone number (required)

Your mobile number

Your e-mail address

Your relationship to the registrant
Mother or Father Partner, Husband or Wife Self Son or Daughter Carer Friend Social Worker Other

If you selected other please state your relationship to the registrant

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The below section is about the individual needing care (the registrant)

Registrant's name

Registrant's date of birth
Day 12345678910111213141516171819202122232425262728293031 Month January February March April May June July August September October November December Year 1901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012
 

Care required
Nursing Care Residential Care Nursing and Residential Care Undecided or Unsure
 

Please tick all care categories that apply
 

Terminal or palliative care

Learning disabilities

Old age

Physical disabilities

Dementia

Drug dependance

Alzheimer's

Alcohol dependance

Mental disorder

Sensory impairment

Please state if any other care services are required

Does the registrant smoke?
Yes No Unsure
 

Estimated start date of the care
Day 12345678910111213141516171819202122232425262728293031 Month January February March April May June July August September October November December Year 20122013201420152016201720182019202020212022
 

Desired location for the care

Maximum distance from the above desired location
miles

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Has the registrant had a social or medical assessment carried out by either the local social services office or primary care trust?
Yes No Unsure
 

Do you require financial advice?
Yes No
 

What are your funding arrangements?
Private Public Both Unsure
 

Do you require legal advice?
Yes No
 

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Any other additional details

Enter the numbers you see in the box:

FAQ

We at Compare Care Homes understand that the process of inquiring about care homes and room availability, let alone placing someone into care, can be quite a daunting and complicated task - especially when faced with the, often upsetting realisation that a family member or friend requires the services of a care home, or care facility.

We are here to help. Our 'Care Request' tool helps you first and foremost by easing the burden of searching for a care home. Using the information that you provide, we contact care homes on your behalf and then contact you to discuss your potential options further. Once we have undertaken a preliminary search of available care homes that meet with your requirements, we will contact you to run through any financial or legal questions that you may have.

This service is free, although we may ask you to write a few words evaluating our service for publication on our website.  All information is dealt with in strict confidence and no details will be passed onto any third party organisation without your permission.

Facts and Figures

Nationally the average occupancy rate for all types of care home including residential, nursing, respite, dementia and EMI care homes is around 90%. Approximately 12,000 people per month move into care homes, and around 40% are self funding, yet only around 7% of people get any financial advice.

Contact Details

For care request enquiries please complete the contact form opposite or if you have any problems email us directly:
support@comparecarehomes.com