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This form is for use by Social Work to:
• cancel an alert alarm and request alert equipment is collected • request service user call/visit history • request information on service user and/or alert alarm information • provide information or update information held on service user • request for a responder to check alarm • report lost or damaged equipment
If you email or phone the 24-Hour control centre, about any of the above, you will be asked to fill in this form.
The service user’s SWIS number is required for the form.
Your email: (Required)
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