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HOUSEHOLDER APPLICATION FORM

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HEALTH & WELLBEING DECLARATION

IMPORTANT HEALTH CONDITIONS DISCLOSURE & DECLARATION
Supportmatch firmly believes in the importance of getting to know our Homeshare Applicants well. Therefore, we ask all our Householders to be as open and honest as possible when disclosing health conditions and personal challenges.

 

This helps us to sympathetically determine and match you to the right Homeshare candidate who will likely be in sync with your needs and ensures a more harmonious Homeshare match. Upholding the welfare and well-being of all parties involved is critically important to us.

 

We continuously manage, monitor and oversee every Homeshare arrangement, and when needed, we will step in and offer mediation to resolve any hiccups or challenges that may occur during the duration of the Homeshare arrangement.


SCOPE OF DISCLOSURE
We ask that you disclose any physical and mental health conditions, regardless of their perceived severity. This thorough disclosure is vital for evaluating the suitability of the Homeshare Arrangement.

CLICK TO READ HOUSEHOLDER TERMS & CONDITIONS


HOUSEHOLDER INFORMATION

HOMESHARE OPTIONS EXPLAINED

1. HOUSEHOLDER (Regular Homeshare):

Select this option if you only need between 10-15 hours per week of Practical Support and Companionship.


2. HOUSEHOLDER PLUS (Homeshare Plus):

Select this option if you need between 20-25 hours per week of Practical Support and Companionship.

PLEASE SELECT APPLICATION TYPE: (Required)

DISCOUNTS & ASSISTANCE EXPLAINED

At Supportmatch Homeshare, we ensure our services are accessible to everyone. If you can’t cover the full monthly fee, we offer a Means-Tested Discount:

REGULAR HOMESHARE: Discounts up to 50% are available, reducing the fee from £150 to as low as £75 per month. For those with little to no financial means, full fee waivers may be granted on a case-by-case basis.

HOMESHARE PLUS: The full fee is £300 per month. Discounts up to 20% are available, lowering the fee to £240 per month. Full fee waivers are not available for this arrangement.

Our goal is to make homeshare benefits accessible to all Householders, regardless of financial circumstances. We assess each Householder’s financial situation individually to determine eligibility for discounts or waivers.

We are here to help you maintain your independence and enhance your quality of life through our services.

For more details, please contact us directly on 0203 633 6066 or email Info@Supportmatch.co.uk. We are here to support you in every way we can.


FULL NAME (Required)

HOUSEHOLDERS FULL NAME

GENDER (Required)
DATE OF BIRTH (Required)
ADDRESS (Required)