New customer enquiry – walk-in

Has a new customer enquired about care? Use this form to capture the information so we can follow this up. Please add the full details using the form below, including details about the customer.

New branch enquiry

Branch name

Branch Manager name

Topic *

Date Received*

First Name*

Last Name*

Service type*

Primary Condition

Postcode

Primary Source*

Email address

Home phone number

Mobile number *

Extra enquiry Information (Include any extra comments & whether the enquirier is the same as the customer)

About the customer (if different from enquirer)

Customer first name

Customer last name

Postcode *

Address *

Town or City *

County

County *

Meeting Booked? (Include date, time, assessor and who the meeting is with)

Please leave this field empty.

Helping Hands Home Care > New customer enquiry – walk-in

Registered office: Head Office 10 Tything Road West Alcester Warwickshire B49 6EP

Registered in England and Wales no. 3959933.

Helping Hands is registered and therefore licensed to provide services by the Care Quality Commission (ID: 1-101671690) and the Care Inspectorate Wales (certificate number: W15/00000831/O001/0001). For more information visit www.cqc.org.uk and www.careinspectorate.wales

* All calls to 0843 numbers will cost you 7p per minute plus your phone company’s access charge.

All calls are recorded for training purposes.

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