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Health Needs Questionnaire

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Items marked mandatory must be completed

Please complete this form if you, or a member of your household, have a problem with your health which would be helped by different housing accommodation.

The highest band, band 1, is only awarded on health grounds where the condition is life-threatening, or the applicant is bed blocking in an institution, or the applicant cannot manage stairs or essential facilities within their property and the property cannot be adapted.

Band 2 is awarded where an applicant is not at risk but their accommodation is unsuitable on health grounds. If the application has already been awarded band 2 due to other housing needs no further priority will be given on health grounds.

For applicants who don't meet the residency criteria but may have a health condition, band 3 may apply.

Please confirm you have read the above statements
Please confirm you have read the above statements mandatory field