Apply for an Access Card

Card holder name
Your name (if different)
Address
Email
Telephone number
Consent

In order for us to be able to make a decision on your entitlement to a card we need to process information related to your medical condition. This is deemed by the Data Protection Act to be sensitive information. We will not do this without your explicit consent. For more information on our Privacy Policy and how we process information please see the website. If you do not give consent we will not process your application and all information will be permanently deleted upon receipt.

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About your Disability / Impairment / Health Condition
Standing and queuing
Wheelchair access
Access to toilets
Assistance dogs
Long distances
Personal assistants / additional support
Accessing visual information
Accessing audible information
Anything else
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Upload a copy of your benefits entitlement or a Dr's letter
Upload photo ID
Upload a photo
Upload anything else you think might be useful
Upload a link to any media about you that you think may help us make a decision
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I consent for Nimbus to send me information which might be filtered based on the information i have provided about my needs and other information
What is your age range?
What kind of things are you looking for?
Sport (playing)
Sport (watching)
Shopping
Online shopping
Eating out
Socialising
Dating
Live music / events
Cinema / theatre going
Social care support
Aids and equipment
Transport / mobility
Holidays (UK)
Holidays (abroad)
Other
Employment status
Ethnicity
Are you in receipt of any of the following?
Direct payments
Disability living allowance / attendance allowance
Personal budget (social care)
Personal budget (health care)
ESA (Employment Support Allowance)
PIP
Other
How did you find out about the access card?
What made you sign up?
Where do you think you'll be using the card?
What do you think about the cost of the card?
If you have a special offer code enter it here
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