Shared Lives enquiry form

Contact Us

I am interested in finding out about Please choose one

Becoming a Shared Lives carer

Being supported in Shared Lives accommodation

Name *

I am completing this form ... *

For myself

For someone else

If you are completing the form for someone else, what is your relationship to them? * Please select all that apply.

Family member

Social worker

Paid carer/PA

Friend

Unpaid carer

Other

What is your relationship, if you answered other? *

Name of the person you are completing it for *

How would you prefer us to contact you? *

Telephone

Email

What number would you like us to call you on? *

What email address should we contact you at? * Please supply an address that you check regularly

Consent for storing submitted data *

Yes, I give permission to store and process my data

Please let us know how found out about Shared Lives ie social media, a leaflet or poster, though a search engine like Google ...

Which part of Shropshire do you live in? *

North Shropshire

South Shropshire

Central Shropshire