You should complete this form if you are named as the first or second applicant on a housing application form and if you, or someone in your household, has a health problem or vulnerability issues.
A 'health problem' can include a physical illness or problem, a mental health problem, or a learning disability and/or a dependency on drugs or alcohol.
This form should only be filled in if:
- The health problems are severe; and
- The person's current home makes them worse; or
- They make your/their current home difficult to occupy
- The person is vulnerable and the location of their home is causing difficulties.
Please do NOT fill in this form if problems are due to:
- Difficulties experienced during pregnancy that are likely to go away once the baby is born
- Difficulties getting a pram/buggy up and down stairs
- Illnesses or injuries that are likely to get better with treatment, e.g. a broken leg or arm or recovering from an operation
- Overcrowded accommodation- we already consider this in the general assessment of your housing situation
- Minor illnesses like a cough, cold, flu, earache etc
- The state of repair to your property, e.g. damp, condensation, infestation with mice or insects. Your landlord or housing manager should deal with these or you can contact us for further advice