Please fill out the relevant form below to complete your application
Download the form to finish your application (please note there are 2 for a stair lift) and email it to aidsandadaptations@midlandheart.org.uk.
Or if you prefer, you can post it to us using the address: FAO Aids and adaptations team - Assets and Delivery, 20 Bath Row, Birmingham, B15 1LZ.
You'll need to fill out both of these forms to complete your application:
