Medical application form
This form is for housing register applicants who have a medical condition that needs to be taken into consideration as part of their application, or who live with someone (who is named on your application) that has a medical condition that needs to be taken into consideration as part of their application.
Medical application form (Word)
Once the form has been completed, please send the form and any relevant evidence to firstname.lastname@example.org
This form is for housing register applicants who want to include someone in their application who needs to live with them on medical grounds. This form is not for the applicant, a spouse/partner or their children. It is to be filled in for other relatives, i.e. parent, niece, nephew, aunt, uncle, grandparent etc.
Household inclusion medical form (Word)
Once the form has been completed, please send the form and any relevant evidence to email@example.com. You must type the word ‘Medical’ in the subject field with the first line of your address to ensure we deal with your form as quickly as possible.
Some examples of why you might be affected by your current home:
- Following a recent accident, an applicant has become permanently reliant on a wheelchair, but they live in an upper floor flat that is does not have a lift
- An applicant has to receive dialysis at home overnight but lives in a room in a shared house and is unable to ensure cleanliness and/or has nowhere to store the equipment needed.
- A hospital discharge cannot take place because the patient cannot return to the home as it is impossible for them to live there.
- A wheelchair user lives in a property arranged over more than one floor and needs easy access to bathing facilities, but lives in a private sector rental property and the landlord has refused to allow a stair lift to be installed or does not agree to the bathroom being adapted.
Please note if you are already in the priority homeseeker (PH) category, an additional award for reasonable preference on medical grounds will not change your status on the register unless you are severely overcrowded, that is lacking at least 2 bedrooms for your household.