CTS 57 referral for minor provision

Please note: only NHS staff and professional organisations can submit a request through this form.
 
This form is for the County Technician Service.
 
Use this form to request provision of minor adaptations such as:
 
  • chair or bed raisers
  • stair rails
  • internal or external grab rails.
 
Do not use this form for:
 
  • requesting temporary wooden ramping (refer to your local team for assessment)
  • equipment orders such as bathing equipment, telescopic ramps etc. (please order through ICES.)

All questions with a red * are mandatory and must be answered in order to progress with the form and more information about the Kent County Council (KCC) data protection policy is available on the KCC website.

Referrer details

Please provide the details of the person referring the individual who needs an adaptation.
What organisation do you work for? *
What organisation do you work for?
Date of Assessment *
Date of Assessment
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