Nuneaton COVID-19 Support - Request Help
If you're self-isolating and need some support you can use this form to request help. If you need something collecting like food, toilet roll, or a prescription we can try to find a volunteer in your area to help or point you to a suitable service.
Your information will not be shared for any other purpose.
Please be cautious. Nobody needs to ask for any kind of payment information, credit card details or bank details for any reason.
What is your name?
Which area do you live in?
What is your full address?
What is your phone number?
What do you need help with? (If you need essential supplies please list the items and we will try to help)
Send me a copy of my responses.
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This form was created inside of Huxo Creative.