Passive Sensor Enquiry Form

Thank you so much for your interest in this important research project, please complete this enquiry form and a member of the Care Network team will be in touch to explain more about the Passive Sensor Project and to make arrangements for installation. (required)

Please tick to confirm that you agree to Care Network contacting you using the details provided below.

Title (required)

Full name: (required)

Email address:

Telephone number:

Address

House number and street name: (required)

Postcode: (required)

The trial of the product is being offered to people who live in Highercroft or Edgeworth, are 50 or older and live on their own. Please confirm that you meet the elegibility criteria by ticking the following boxes: (required)

I am 50 years old or older I live in either Highercroft or EdgeworthI live on my own

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