Skip to main content
Hafod influence
Our leadership team
Our mission
English
Cymraeg
Search
search
Search
Toggle Menu
Homes and communities
Expand Homes and communities
Back
View Homes and communities
Report a repair
Anti-social behaviour
Expand Anti-social behaviour
Back
View Anti-social behaviour
Rent and service charges
Your Coaches
Get involved
Complaints and compliments
Move or swap your home
Care
Expand Care
Back
View Care
Brocastle Manor
Cwmbran House
Gwynfa
Picton Court
Plas y Garn
Tŷ Penrhos
Woodcroft
Complaints and compliments
Housing related support
Expand Housing related support
Back
View Housing related support
Floating support
Partnership working – support
Report a repair
Hafod influence
Our leadership team
Our mission
English
Cymraeg
Request a physical adaptation
Are you the tenant, or are you completing this form on behalf of the tenant?
(Required)
I am a tenant
I am filling this in on behalf of a tenant
Have you already been issued a report from an occupational therapist or trusted assessor for the relevant physical adaptaions?
(Required)
Yes
No
Upload a copy of the report
Please upload a copy of the report from an occupational therapist or trusted assessor for the relevant physical adaptations
Max. file size: 64 MB.
You must provide this report for your request to be considered by our team
How to request a repot
To be issued a report, you can contact your GP to ask for an occupational therapist referral or you can refer yourself to the occupational therapist team in your local authority area
(Required)
I understand
If you would like to send us a copy of your report once it has been issued, you can email it to PAG@hafod.org.uk along with your full name and address.
Tenant information
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
Postcode
Tenants date of birth (dd/mm/yyyy)
(Required)
Date of birth of all household members (dd/mm/yyyy)
Tenants registered GP and surgery address
(Required)
Street Address
Address Line 2
City
Postcode
Details about you
Name
(Required)
First
Last
Your relation to the tenant
(Required)
Email
(Required)
Phone
(Required)
Adaptation request details
Adaptation(s) required
(Required)
Level access shower
Wetroom
Ramping
Adapted kitchen
Stairlift
Other adaptation(s) required (please specify)
Past medical history
(Required)
Please include as much detail as possible
What difficulties are being experienced in the current property?
(Required)
Please include as much detail as possible
Is there any additional relevant information that we should be aware of?
(Required)
Please include as much detail as possible