Enhanced Telecare

Fair Processing Notice
To find out how we will process and use personal information in connection with this request please see our Privacy Statements.

This form should only be completed by Health or Social Care professionals who are employed by Glasgow City Health and Social Care Partnership (GCHSCP)
If you are not a Health or Social Care professional employed by GCHSCP and you complete this form, the application for a service will not be progressed. You should complete the standard request for Telecare
Please note that there are delays with the installation of some devices due to supply issues. Emergency referrals are currently being prioritised until stock levels return to normal.
Label
1. What type of service are you applying for? Please only choose one
2. Label
  
  Enhanced Service Request for existing Telecare User
  
  Enhanced Service Request for new Telecare User
3. Why is a Telecare Service required? Please only choose one
4. Label
  
  Due to a fall within the last year
  
  For safety and reassurance within the home
  
  To maintain independence
  
  Carer Support
  
  To assist a return home from hospital
  
  NW TECS Project
5. Please specify planned discharge date
Label
1. Referrers Details
2. First Name*
3. Second Name*
4. Work address*
5. Postcode*
6. Work phone number*
7. Mobile phone number
8. Work email address*
9. What is your relationship to the person who requires the Telecare service?*

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Council Services

Enhanced Telecare

This form should only be completed by Health or Social Care professionals who are employed by Glasgow City Health and Social Care Partnership (GCHSCP)

Referrers Details