NEP Self Referral form 2023

  • Please complete this form so we can understand your property, financial and personal circumstances better. We can then determine which project or service is best suited to your needs.
  • Which services are you interested in?

  • 1. Personal Details

  •  - -

  • 2. About your Property

  • What's your property type?*
  • Are any children aged 16-20 in full time education?

  • 3. Insulation & Heating

  • What's your wall type?*
  • Does your property have cavity wall insulation? *
  • Does your property have solid wall insulation?*
  • Is your loft insulated?
  • If yes, what's your loft insulation depth?
  • Loft type/features
  • How do you mainly heat your home?*
  • How old is your heating system?
  • What's your main fuel type?
  • Please select a secondary heating type (if you have one)
  • Do you have a Solar PV system on your roof (generates electricity)?

  • Heath & Benefits

  • Does anyone in the property suffer with a long-term chronic illness? select all that apply.*
  • Does anyone in the receive any benefits? Select all that apply.*
  • Does anyone in your property receive 'self declared' benefits? If yes, select all that apply.

  • Final Section

  • When would you prefer to be contacted?*
  • Where did you originally hear about us?
  • Should be Empty: