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New Client Joining & Risk Assessment Form
Welcome to Live a Little Joining/Risk assessment form.

We will make sure to help every single client individually to reach their own goals. Therefore we have a joining and risk assessment form thats needs to be completed so we can help manage the clients needs.

All information provided will be treated in confidence and held under the data protection act. A member of Live a little staff may need to contact you to discuss the application further.

Thank you.

Full Name *
Your answer
Are you currently a Live a little client? *
Email Address *
Your answer
1st line of address
Your answer
2nd line of address
Your answer
County
Your answer
Postcode
Your answer
Telephone Number
Your answer
Primary Emergency Contact Person Name
Your answer
Primary Emergency Contact Person Contact Number
Your answer
Relationship to Participant
Your answer
Secondary Emergency Contact Person Contact Number
Your answer
Relationship to Participant
Your answer
Secondary Emergency Contact Person Name
Your answer
Relationship to Participant
Your answer
Who will be funding our service ? (e.g. Local Authority; Direct Payments via an Account Holder; Direct Payments paid directly to Live a little; privately; another source?)
Your answer
Live a little offers primarily Social Care; we are able to offer some Personal Care in community based venues. assistance with feeding, going to the toilet or dressing. Please explain what sort of assistance, if any, is required, and we will be in contact to talk things through.
Your answer
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