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Request Service/Support

Request a service or client support

From time to time a client may need support with the unit or you may wish to request that the unit is serviced. Therefore, to request a service or support please complete this form and click on Submit. Please do not provide any detail on the Clients condition or medical history. All information supplied is encrypted once submitted and is stored securely in full compliance with GDPR guidelines.

 

An Eircode is the most accurate way of providing an address so please endeavour to supply one for each new client.

 

It is imperative that at least one active telephone number is supplied for every client, either a direct number for the client and/or for a carer. The more contact numbers provided the easier it will be for Lyncare to make contact. Any clients submitted without an active telephone number will be rejected.

 

 

* Fields marked with an asterisk are mandatory.

    Client Details











    Carer Details








    Prescriber Details






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