New Client Form - Assistly Salford

Thank you for your interest in working with me. Please fill out the New Client Form below. Once submitted, I will get in touch via your preferred method of communication to confirm a start date and pricing.

Name *

Email Address

Phone *

Street Address *

City

Postcode

Communication preferencesPlease let me know how you prefer to be contacted. You can select multiple, if needed, or select your own.

Other communication needs- If preference for email, text, or phone call is dependent on situation - Times of the day to avoid calling - Preference for standard communication like requests for visits - How to handle urgent communications like sickness absence - Would you prefer a list of topics to discuss ahead of the initial meeting? (Changes can be made at any time - just let me know)

Emergency contact(s)Full name, phone number, address, relationship

What do you want me to know about you/your household?Please share anything that would help me understand your needs, preferences or circumstances and provide the best support possible. This could include disabilities or health conditions, allergies or intolerances, dietary requirements, neurodivergence or sensory needs, mobility needs, routines, things that may cause anxiety or overwhelm, pets, or anything else you feel would be helpful for me to know.

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