This form will ask you to provide
- Your details.
- Your address and application address (if different).
- The name of the person receiving care.
- The address where they are receiving care and the date they moved to this address.
- The reason care is being provided and the type of care being provided.
- The doctor's name and address of the person receiving care.
Please have this information ready as pages time-out after one hour.
Do not use your browser back button when completing this form. If you need to go to a previous page, please use the ‘previous’ button at the bottom of each page.
Dover District Council is a Data Controller under GDPR. In submitting this form we will collect and process your personal data. For information about your rights and how the Council uses your data, please view our Corporate and relevant service privacy notice which can be found on our Privacy Page.