Priority Services Register

This form can be used for initial registration or to provide updated details.

Before completing this form, please check that you are connected to a Last Mile network.

For guidance on how to check, please see Check Who Your Distributor Is.

Your Privacy: We will only use the information you give us when signing up for the Priority Services Register to give you information on planned and unplanned interruptions to your gas and/or electricity supplies, advice about precautions you can take in the event of any interruption and to provide services and support should an interruption actually occur. We may share your information with other energy companies and other third parties who can assist us to manage, deliver and improve this advice, service and support but we will share information about health and infirmity only where it is in your vital interests (eg in an emergency), or we are required to do so by law or you have otherwise given your consent. We will never use your information for marketing purposes.

For further information, click here to view our privacy policy.

Please let us know what your household needs are by selecting the relevant boxes below. You can also provide any additional specific information at the bottom of the form.

All fields marked with * are required before submitting the form.

Please select all of the below that apply to you.

1. Nebuliser and apnoea monitor

2. Heart, lung & ventilator

3. Dialysis, feeding pump/automated medication

4. Oxygen concentrator

5. Blind

6. Partially sighted

7. Hearing/speech difficulties (inc. Deaf )

8. Stair Lift, hoist, electric bed

9. Pensionable age

10. Physical impairment

11. Unable to communicate in English

12. Developmental condition

13. Unable to answer door

14. Dementia(s)/cognitive impairment

15. Chronic/serious illness

16. MDE electric showering

17. Careline/telecare system

18. Medicine refrigeration

19. Oxygen Use

20. Poor sense of smell

21. Restricted hand movement

22. Families with young children 5 or under

23. Mental health

24. Additional presence preferred

25. Temporary - Life changes/other

26. Temporary - Post hospital recovery

27. Temporary - Young adult householder (under 18 years of age)

Would you like to set up a password that can be used to verify our staff on site or allow a nominated contact to speak to us on your behalf?

I acknowledge that I have read, and agree to, Last Mile Asset Management's Privacy Policy.*