People who are of pensionable age, disabled, chronically sick or have sight or hearing difficulties can qualify for their supplier’s PSR. Dependent on circumstances, PSR customers can access services such as: Free gas appliance safety check Relocation of pay as you go meter for improved access Password protection scheme Quarterly meter readings Bill nominee scheme Advance notice of supply interruptions Priority support and reconnection in the event of supply interruptions Bills in alternative formats For more information please contact us on 024 7625 3190 / wpd@coventrycab.org.uk. To register yourself please complete the form and we will be in touch as soon as possible. If you think you could benefit from the Priority Services Register Please fill out the form below. Title (required) First Name (required) Surname (required) Your Address Postcode Your Email (required) Telephone No Mobile No Do you or anyone in your household rely on electricity for home medical equipment? * YesNo [group group-302] If so, what medical equipment do you use NebuliserHeart/Lung machineHome Kidney DialysisOxygen ConcentratorVentilatorApnoea MonitorOther [group group-125] If you answered Other to the above, please specify [/group] [/group] Do you have a stair lift or bath hoist? * YesNo Please tick the box if you or someone in your household fits into any of the categories below? Over 60 years oldBlind/partially sightedDeaf/ hearing impairedDisabledSpeech/ learning difficultiesRestricted movementDementiaForeign language speakerTemporary registrationOther medical condition [group group-303] If you answered 'Foreign language speaker' above, please specify your first language here [/group] [group group-304] If you answered ‘Temporary registration’ above, please tell us your reasons for needing to be registered temporarily here [/group] [group group-305] If you answered 'Other medical condition' above, please specify here [/group] Please provide us with any other important information that you would like to tell us below Nominated contact name YesNo [group group-927] Nominated contact name Nominated contact number [/group] Important Information – please read: By submitting this application you are giving Citizens Advice Coventry permission to share your information with Western Power Distribution for the purposes of registering you on their Priority Services Register. Western Power Distribution may share your details with local responding agencies, trusted charities such as the British Red Cross or your local resilience forum. Your data will never be used for marketing purposes. If you would also like us to share your information with your energy/utility suppliers, networks and meter operators so they can register you for their priority services, please tick this box. I agree Where did you hear about us? *
