Stirling Council Housing And Customer Service Housing Application Form Page 6
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321.5 Health and Housing
To ensure that we can consider you for housing that meets all of your and your household’s
needs, we need to know if you or anyone to be housed with you have any particular health
issues/problems? Please tick (4) the box below.
Do you or anyone to be housed with you have a medical condition
Yes
No
that is affected by your current housing circumstances ?
Do you or anyone to be housed with you require any special
Yes
No
equipment or adaptations to live in your home? For example
handrails, ramps etc. If yes, please tell us about these briefly
below:
Do you or anyone to be housed with you need any assistance or
Yes
No
support to live at home, for example people that help you look
after you/or someone who lives with you? For example a support
worker, carer. Please tell us details briefly below:
Yes
No
Do you or anyone to be housed with you need an extra bedroom
because of a health problem or disability? If yes, please tell us
briefly why you need an extra room below:
If you have answered Yes to any of the above questions, please complete a Medical Application
Form. The Applicants Guide gives you further details about this application. Please complete
the application as fully as you can. The details about how to return the Medical Application
Form are detailed on the form itself.
If you require a Medical Application Form please contact us:
Stirling Council Contact Centre 0845 277 7000 and ask for Housing and Customer Service
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