Christies Care Client Enquiry Form

Client Enquiry Form

Thank you for asking about having a care assistant from Christies Care.

Please fill in the boxes below and send them to us and we will get back to you as quickly as possible.

WHAT DO YOU WANT FROM US?

We can send you our booklet, which includes our terms and conditions. It will tell you about us but it will not give you more than a guide to cost and the availability of care assistants.

We can add to our booklet and ring you up or email you with an outline of cost and when we can start.

We can reply to a more urgent enquiry for help - where you want a care assistant within a few days or a week perhaps.

PLEASE GIVE US YOUR PERSONAL DETAILS.
NB We will only use these details to get in touch with you about our service. By giving them to us you agree that we can do so. We will not release your details to anyone outside our company.
Surname (required):
Title:
Forename:
Address:(required)
(required)


Post Code:(required)
Tel No:(required)
Where Did You Hear About Us?
Publication or Organisation Details (if applicable)
Your Email:
Do you want us to send you our booklet?	Yes No

Do you want a care assistant:	within the next few days or do we have two weeks or more?
Do you want us to ring or email you so that we can give you a firmer guide to cost and availability?	Yes No
If you answered yes above please give us additional details: Why do you need a living-in care assistant?
How would you like us to contact you?	Telephone Email

Do you want help quickly?	Yes No
If you answered yes above please give us additional details: How are you being looked after at present?
Have you all the necessary equipment in your house to help our care assistant help you?	Yes No
Is there a separate and comfortable room for our care assistant ?	Yes No
When do you need help?
For how long?