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CE CARE LIMITED

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FULL NAME

AGE

Email

Do you currently claim any DLA or PIP benefits?

Phone Number

Click below what you suffer with :

Arthritis

Asthma / COPD

Heart related conditions (such as High Blood Pressure/High Cholesterol etc)

Diabetes

Brain injury - Stroke/ Brain Hemorrhage

By filling in this form, you hereby grant permission for us to contact you regarding the information provided. We respect your privacy, and your personal data will not be shared with any third parties. This consent is solely for communication purposes related to the content of this form.

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