I confirm I am registering this person to support their needs and that the information provided is needed for Priority Services. Any personal data will be used in line with our Privacy Policy

Your Priority Services options

Please change or add to your options below

The person being registered for priority services is Name here

Is the person being registered affected by any of the following?

Please select one or more of the options if applicable

Is the person being registered affected by any of the following?

Blind

Partially sighted

Deaf

Hard of hearing or hearing impaired

Dementia

Developmental condition such as Autism

Restricted mobility

Learning disability

Dialysis machine

Mental health issues

Speech impairment

Physical impairment

Elderly

Chronic / serious illness

Is the person being registered affected by any of these circumstances?

Please select one of the following (optional)

Is the person being registered affected by any of these circumstances?

Bereavement

Divorce or job loss

Pregnancy and families with babies

Young adult householder

Post hospital recovery

None

Would the person being registered have difficulty collecting an alternative supply of water in the event of a water supply disruption?

Please select one option

Would the person being registered have difficulty collecting an alternative supply of water in the event of a water supply disruption?

Yes

How can we support the person being registered?

Please inform us of any additional information

Please use the box below to tell us anything about your circumstances that will help us support you. This is optional.

How can we support the person being registered? number of Characters remaining: 500

You can set a password so our team can prove their identity when they visit

Protect your home with our password scheme, so all you need to do is ask for a password from our team when they knock on your door.

Password (optional)

How would you like your bill?

We can give you your bills in Braille, large print, audio CD and more

How would you like your bill?

A standard bill

Braille

Large print

Audio CD

Call me to explain my bill

Easy read

How did you hear about the priority services register?

Where Did You Hear About Us

I confirm I am registering this person to support their needs and that the information provided is needed for Priority Services. Any personal data will be used in line with our Privacy Policy.

Just one more thing...

With an online account, you can easily update your Priority Services choices in the future

Would you like to create an online account?

Create online account tooltip

Would you like to create an online account?

Thank you ##Firstname. Registration complete

We've updated your choices

Your Priority Services selections have been saved. Your confirmation number is We'll update this account within 10 days. Your confirmation number is Online account created, look out for email. Your confirmation number is Contact Id

You may receive a short survey about your contact with us. We use this to help improve our services.

Back to Priority Services

Back to My Profile

Back to Notification