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Lamplight pre-appointment questionnaire
If you experience any technical issues with this form, please contact the Lamplight Support Service at email@example.com
Fill out this form ahead of your appointment. All the information you provide is treated confidentially.
Only complete this form after you've booked an appointment with the Lamplight team.
If you do not have an appointment booked, please type TBC
An example of capital could be a property you don't live in.
Other income sources could include maintenance for children, or an occupational pension
Please enter the monthly amount of any benefits you receive
If you do not have a partner living with you, or your partner does not work, then you do not need to complete this section.
Please enter the amount of any benefits your partner is receiving
An example of capital could be a property they don't live in.
(e.g. occupational pension, or maintenance)
Please enter your monthly expenditure on the following items
(e.g. rent, mortgage, board, etc. Please tell us the amount stated on your contract or agreement. If you’re currently paying a different amount because of benefits or arrears, please tell us the original, contractual figure, not the amount you actually pay.)
(Ignore any benefit you may receive towards this)
(Do not include payments towards arrears.)
(e.g. nursery, registered child minders or childcare provided through school.)
(for children not living with you)
(due to ill health or disability)
(Please exclude fuel costs)
Please list any debts you may have and how much you pay towards them each month. This may include credit cards, personal loans, store cards, arrears for council tax and utilities.
We appreciate these won't be your only costs. Please have figures for costs not included above to hand at the time of your appointment. You don't need to add them in to the above sections.
By submitting this form, you are giving the RCN permission to contact you about your submission.
You can control the information you receive from the RCN by updating your preferences at MyRCN.
The information you provide in this form will be stored by the RCN.
Royal College of Nursing