Independent Living Referral Form

Consent for storing submitted data

Yes, I give permission to store and process my data

Thank you for choosing Cornwall Housing’s Lifeline service. We offer a range of assisted technologies to help promote independent living to vulnerable people across the county.

We are currently expanding our service and are able to take referrals from homeowners, private rented and Housing Association tenants as well as people living in Cornwall Council properties.

Please ensure this form is completed in full, as it may delay the installation if we need to gather further information.

Referral completed by:

Organisation referral
Private referral

First name

Last name

Address

Post code

Telephone number

Relationship to person being referred