WPForms Preview

This is the WPForms preview page. All your form previews will be handled on this page.

The page is set to private, so it is not publicly accessible. Please do not delete this page 🙂 .

 

Your Well-being Check

E.g. Son, Daughter, Partner, Lodger etc

About You

Single, Married, Cohabiting, Divorced, Widowed
E.g. Straight/Heterosexual, Bisexual, Lesbian, Gay

More About You

The questions in this section may seem intrusive, and this we know. The whole point of these questions is for us to know enough about you, especially in a case of an emergency.

Knowing this information could help us to support you better and adequately, if we ever find that we are seriously worried about your well-being, which also include your whereabouts.

Please note that if we have to contact the NHS in an emergency, we will ONLY disclose the information we know are needed, if asked. We have the right under the law to protect all the information you disclose to us, and we must also abide diligently by this under the law

E.g. Hobbies, likes, dislikes etc.

Other Support We May Be Able To Offer

By moral support, we mean to be a friend. We will not support you in decision making, we will not make any medical decision on your behalf, we will not support you to administer any treatment. It is purely to have someone by your side. A shoulder to cry on. Do you understand this

About Your Next of Kin

About your other Significant Person

Next Page *

Anything Else

reCAPTCHA is required.