Completion Note
You should complete this form if you or any member of your household have a medical condition which is made worse by living at your current property.

A separate form should be completed for each member of your household who has a medical condition which is made worse by living at your current property.

Please note: Having a medical condition may not lead to points being awarded; points will only be awarded where rehousing will have a positive impact on a medical condition.

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* Main Applicant Details

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* Main Applicant Address

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* Details of person with medical condition

6% of survey complete.