Communications Centre

The Careline Scheme

Please fill in the form below to make a request for the Careline Service.

* Please note this service is only available for residents in Barking and Dagenham.

Click the Submit button at the end to send the form.

Please make sure you fill in the fields marked with *

Surname: *

Forename: *

Street: *

City / Town: *

County: *

Postcode: * No space

Telephone (Work/Home): *

Telephone (Mobile):

Date of Birth:* (for example 01/01/1970)

Age today: *

If you are completing this form on behalf of someone else, please let us know your details:

Personal Surname:

Personal Forename:

Telephone (Work/Home):

Telephone (Mobile):

Your relationship to the person requiring the service:

I am applying for a Care alarm service:

Because of a serious health problem or medical position

Because of a disability

To feel more secure

Because I live alone

For another reason:

Contact

The Careline Department

Roycraft House

15 Linton Road

Barking

IG11 8HE

Tel: 020 8227 3083

Fax: 020 8227 3470

Email: careline@lbbd.gov.uk|

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Rainham Road North

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RM10 7BN

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