Community Alarm Referral Form


This is a chargeable service
  Weekly Charge Annual Charge *
Single £2.80 £145.60
Couple £2.80 £145.60

* = Invoices are sent out annually in May for the period of April to the following March. If an alarm is installed part way through the year then an invoice will be sent for this period to the end of March. Annual invoices will be sent from then on.

Couples will need to fill out a form for each person.


During this form we ask for the keysafe access code. Our customer advisors copy this information into the Health and Social Care database.

If you don't have keyholders or a keysafe, we may have to force access and there may be charges for any damage incurred.

This form asks for the following information:

  • Detailed Health information
  • Information on services currently received
  • Information regarding your Personal circumstances
  • Access information (property)
  • G.P. Information
  • Next of Kin information
  • Emergency Contact Information

Privacy Policy

Community alarm Privacy Policy

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