LiveYou Client Intake
In order to create the perfect support packages for our clients, LiveYou may need to collect personal information from each of our clients- this helps us gain a good understanding of our clients needs and helps us to ensure we can offer tailor- made support. To view our GDPR policy see our website www.liveyou.co.uk or for questions on how your data may be stored or used contact a member of the team.
Who we support
LiveYou support disabled people with high level needs to access care support and live a great quality of life. We are not an independent advocacy service or a care agency, we are a specialist service to support disabled people with high level of needs.
Name
*
First Name
Last Name
Email
*
example@liveyou.com
Phone Number
*
Please enter your Phone Number
Date of Birth
*
-
Day
-
Month
Year
Please enter your Date of Birth
Disabilities or Health Conditions
e.g: Cerebral Palsy
Do you need support with the following?
*
Rows
Fully able
Some assistance required
Assistance required
Intermittent Support Required
Preparing food
Consuming Food
Preparing a Drink
Consuming a Drink
Showering/ Washing
Brushing Teeth
Toileting
Fully Dressing/ Undressing
Partial Dressing/ Undressing
Maintaining Living Environment
Taking Medication
Transfers (e.g wheelchair to sofa)
Accessing the community
Support with Medical Equipment (e.g oxygen, catheters)
Communication
Do you require support during the night?
*
Yes
No
Occasionally
Do you require support from more than one PA/carer at a time?
*
Yes
No
Occasionally
Please select the following if they apply to you
*
I have had a needs assessment
I have a support plan in place
I receive Direct Payments
I have had a CHC assessment
I have a social worker
I have a PA
My support is funded by CHC
My support is funded by my council
I have enough hours but I need new PA's
I am unsure
I don't know where to start
Do you currently receive direct payments or have personal budget for your care?
*
Yes
No
I have applied
I'm unsure
How many hours of support do you feel you require per day?
*
*at present we are only able to support clients requiring full - time care packages. We apologise for the disappointment this may cause.
How many hours of support are you currently receiving per day?
*
Please enter a number
Which Local Authority funds your support?
(e.g: Brighton and Hove Council if applicable)
What do you do in your spare time/ what would you like to do with the support of a PA? Are there any other areas of your life where you may need support?
Do you have any hobbies, like to go to cafes, work, or go to university?
Please provide any additional information you wish to tell us.
Including any information about your conditions and what support you may require
Submit
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