Professional Referrals

Welcome to the Connected Living professionals referral service. Please complete the form below and attach your supporting documents. Your request will be sent to the Connected Living Customer Services team as a priority. If sent outside of our normal working hours, your referral will be actioned the next working day. If you need to speak to a member of the team, please call 0333 400 8299 during our normal office hours.

* required field

Organisation*

Name of Referrer*

Job title / Position held*

Email Address*

Contact number*

Referral code

Has the customer given consent for this to be arranged and their details to be shared with us?*

Customer name*

Customer Address*

Customer Contact number/Emergency Contact number*

If applicable, the Serial ID of the Alarm (located on the bottom of the unit above the barcode)

Solution required*

Does the customer have a key safe?

Does the customer need a key safe?

Does the customer need any other equipment?

Supporting information

Who will be paying for the equipment?*

Are there any risks that we need to be aware of?*

Allowed files: PDF, DOC, DOCX, GIF, JPG, PNG, MPEG, MP4, AVI, WEBM, MOV, WMV

File size limit: 20MB

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Search