Housing Medical Assessment Form

Guidance for Applicants

We recommend that you provide relevant supporting information such as GP or consultant letters to support your application.
These must be uploaded directly to your online HomeChoice application.

This form should be completed if:

• Your current accommodation is unsuitable for you due to your physical health, mental health or learning difficulties. Or;
• Because of your health issues you require a specific form of accommodation, such as a specific floor level, property size, property type or disabled adaptations such as a level access shower or wheelchair accessible accommodation.

You should complete this form for the household member that has the specific medical needs. Complete more than one form if necessary.

The assessment will be made based on the evidence provided by the applicant, occupational therapists and other health and social care professionals. However, you would have to pay any fee your doctor may charge for providing supporting information.

Please make sure that you have read and agree to the Council’s privacy statement.

It is a criminal offence to knowingly or recklessly give false information to support your application to the housing register. If false or misleading information is provided the council may pursue a prosecution, your housing register application will be closed and you will be disqualified from the housing register for a period of up to 5 years. If you obtain a tenancy as a result of false or misleading information, the landlord may take court action to evict you and you may be prosecuted.

The information you provide will be made available to any provider of housing before an offer of accommodation is made. By completing this form you give permission for Cherwell District Council to share this information with housing providers and other organisations for the purposes of verifying information, detecting fraud and safeguarding residents and staff.

If you need any help completing this form, please email us on housingregister@cherwell-dc.gov.uk or phone 01295 227004

Please note: You have 10 minutes to complete each page. If you feel you need longer than this, please write your answers in a separate document, then copy and paste this into the form. This is to prevent any information being lost during the form completion.
If you would like to save your progress throughout the form, you must first sign up for an account.