Use the form below to enquire about Careline Community Service products and services. We will contact you with advice and a no-obligation quote.
A map and postcode list of the areas we service can be found HERE. Please check we cover your location before completing the enquiry form.
If you are unable to complete the form for any reason, please call us on 01553 616200, option 1.
In the form below, any field marked with * is mandatory.
Are you contacting us for yourself? Or on behalf of someone else?
If for yourself, please complete sections 2 and 3 only.
If for someone else, please complete all three sections.
Section 1: Your contact details
Relation to clientFamilyFriendGuardianCarerOther
Title
First Name
Surname
Your phone number
Your email
We will call you from 01553 616200 to discuss the alarm user’s requirements. Please save this number. We will only email you if we cannot reach you by phone.
Section 2: Alarm users details
First Name *
Surname *
Date of Birth *
House Name/Number *
Address Line 2 *
Address Line 3
County *NorfolkSuffolkCambridgeshireLincolnshire
Postcode *
Telephone 1 - the alarm user’s phone number *
Telephone 2 - an alternative number, if there is one
Alarm user’s e-mail address, if there is one.
About the property above, please tick one.
Owner / occupier
Housing Association / Council
Private rented
Mobile home / houseboat
Section 3: Further details
Where might you / the user need a Careline alarm? Tick all that apply.
In the home and garden
At home and away, on walks etc.
With automatic falls detection
Please tick any other items which may be of interest.
Key safe
Smoke alarm
Carbon Monoxide alarm
Who should we contact regarding this enquiry? *The person in Section 1The alarm user
How did you hear about us? *Social servicesHospitalLeaflet/poster/advertGP Surgery/Community health teamWord of mouthAt an eventOther
If "Other", please say how.
I agree that I have read, understood and agree to the terms in our Privacy Policy *
2 + 1 = ?Please prove that you are human by solving the equation *
