Apply for care with Helan Home Care

Request care or support

Need care or support? Don’t hesitate to request it via this form. A member of staff will get in touch with you as soon as possible.

Do you need urgent home nursing care? Call 02 218 22 22, select your language, then choose option 2 followed by 4.

Fill in the required fields indicated with a *

My details

First name*

Last name*

Street*

House number*

Box

Postcode*

City*

Email*

Phone number*

Date of birth*

Day *

Month *

Year *

National Register Number

Requested care or service*

Home nursing (call 02 218 22 22 if urgent)

Home care (personal care or household help)

Cleaning service

Handyman service

Palliative care

Home sitting service

Hot meals

Personal alarm system

Advice on aids and/or home adaptations (occupational therapy)

Preferred start date*

Day *

Month *

Year *

Comments*

Personal advice via video

Ask your question to a customer adviser and receive tailored advice. Schedule a video call whenever it suits you. You can instantly see availability and never have to wait long.

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