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  • Priority Services Registration

  • Please complete all fields marked *
    About you
    First name help text
    Last name
    Property name or number
    Address line 1
    Address line 2
    Home phone is required
    Mobile phone
    Text phone
    If you would like to nominate a person as your contact for priority services, please tick below.
    Nominate contact
    Nominate contact
    Home security visit: if you would like us to use a password when we visit you, please enter it below (no more than 10 characters).
     If you would like us to use a password when we visit you, please enter it below (no more than 10 characters).
    Registration reasons
    Please let us know your reasons for registering ticking all below that are applicable to you or someone in your household:
    Nebuliser or Apnoea Monitor
    Heart / Lung Machine or Ventilator
    Dialysis, feeding pump and automated medication
    Stairlift, hoist or electric bed
    Oxygen Use
    Oxygen Concentrator
    Careline or Telecare
    Medically dependant showering/bathing
    Other electrical equipment which you rely on for your health, please specify below
    Medical Equipment type
    Please tell us any other reasons: (tick all boxes that apply)
    Partially sighted
    Hearing impairment (inc deaf)
    Mental Health
    Additional presence preferred
    Restricted hand movement
    Over 60
    Physical impairment
    Medicine Refrigeration
    Dementia(s)/Cognitive impairment
    Families with children under 5
    Developmental Condition
    Temporary - Young adult householder under 18
    Chronic illness
    Temporary - post hospital recovery
    Temporary - life changes
    Speech impairment
    Water Dependant
    Unable to answer door
    Poor sense of smell/taste
    Other information
    English is not my first language
    Please specify your first language if not english
    Select the how did you hear about us choice
    Other information for hear about us choice
    What submitting this form means to you

    Terms of registration

    By submitting this form you are confirming that you understand we may need to pass details to a third party such as British Red Cross, Local Authority or Emergency Services, in order to provide you with priority services.

    We will not use or pass your details to a third party for marketing purposes.

    If you have a nominated contact, you are giving your explicit consent for us to talk to your nominated contact on your behalf when providing priority services. This may mean we will share information about you and your electricity supply with them

    Terms of registration consent

    Sharing your details

    With your consent, we can pass your details onto your energy supplier who may also offer services you can benefit from; like a nominee scheme, accessible information and a password protection scheme.
    Sharing your details consent