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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 *
Are you currently a Live a little client? *
Email Address *
1st line of address
2nd line of address
County
Postcode
Telephone Number
Primary Emergency Contact Person Name
Primary Emergency Contact Person Contact Number
Relationship to Participant
Secondary Emergency Contact Person Contact Number
Relationship to Participant
Secondary Emergency Contact Person Name
Relationship to Participant
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?)
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.
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