Client Application Form

Kabmans Healthcare Limited

Thank you for considering Kabmans Healthcare Services for your care needs. This form helps us understand your situation and ensure we can provide the best possible support for you or your loved one.
Please complete all sections below. If you have any questions, please contact us on +44 7723 803878 or email customerservice@kabmanshealthcare.co.uk

Name

Date of Birth

Phone Number

Home Address

Postcode

Please select the type of care you require (tick all that apply) *

Please describe your care situation in more detail (use additional pages if needed) *:

When do you require care to start? *

As soon as possible (within 1-2 weeks) Within 1 month Flexible/To be discussed Other (please specify):

Preferred care schedule (tick as appropriate) *

Daily visits (specify hours per day): Overnight care (specify nights per week): Live-in care (permanent or temporary)

Any specific days/times preferred?

Health & Medical Information

Current GP / Practice (if applicable)

Name

Phone

Known allergies or medical conditions we should be aware of? *

Emergency Contact

Emergency Contact Name

Relationship

Phone Number

How Would You Like To Hear From Us?

Phone call Email SMS / Text message WhatsApp

Data Protection & Consent

Please note: Your information will be processed in accordance with GDPR and our Privacy Policy. We will only use your data to provide care services and contact you about your enquiry.

I consent to Kabmans Healthcare contacting me about my care enquiry I have read and agree to the Privacy Policy I would like to receive updates about Kabmans Healthcare services

Please return this completed form to: Email: customerservice@kabmanshealthcare.co.uk Phone: +44 7723 803878 Our team will review your application and contact you within 2 working days to discuss your needs and arrange a consultation.