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Small scale adaptation request form

Tenant and request information

Tenant name

Address

Name of the person requiring adaptation

Preferred method of contact

Email

Letter

Telephone

Email

Postal address

Telephone number

Description of the problems being experienced in the home

Type of adaptation needed

External grab handles

Internal grab handles

Second stair handrail

External handrail

Keysafe

Steps to external door (maximum 2 together)

Support rail to external steps

One additional electrical socket (for specialist equipment only)

Paint edge of steps in White or Yellow

Other

If 'other', please state the type of adaptation needed

Data consent and spam protection

Consent for storing submitted data

Yes, I give permission to store and process my data

Spam protection

Page last updated 10 September 2025

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