If you are completing the form on behalf of someone else, for example a child, put your name here.

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. Nimbus Disability is Croydon Councils partner in providing you with your access card.

For more information on their privacy policy please visit: Accesscard.org.uk/privacy-policy/. If you do not give consent we will not process your application and all information will be permanently deleted upon receipt.

Use this space to tell us a bit about your actual medical conditions and diagnoses - this isn't the most important part of the form as we want to concentrate on what your needs are. We do however need to show that you are a disabled person as defined by the Equality Act.

If your impairment means you are unable to stand / queue for significant periods of time – for example you have difficulty standing or perhaps find queuing distressing or have difficulty with the concept of queuing, tell us about that here.

If you are a wheelchair user and require access to wheelchair accessible facilities such as ramps or wheelchair user spaces at theatres etc tell us about that here.

If your impairment means that you need quick access to toilets (either accessible or not) tell us here. For example you may have a condition like Crohn's and would need quick access to the nearest available toilet.

If you require an assistance dog tell us more about that here.

If you are unable to move yourself any more than very short distances – this includes self-propelling a wheelchair, let us know about that here.

If you have to have the support of another person to make use of the facilities of a service let us know about that here. For example you need personal assistance with your care or perhaps without another person you wouldn’t be able to make purchases and carry things like food and drinks.

If you have difficulty accessing visual information such as written information or understanding signage please tell us a little here.

If you have difficulty accessing audible / spoken information for example you are Deaf or have a hearing impairment please tell us a little about that here.

If you impairment has any other impact on your ability to access a service tell us about that here - this will flag to service providers that you might need support which otherwise wouldn't be identified on the card.

This is to upload any evidence you have to support your application. It might include copies of Doctor's or Occupational Therapists letters this might be benefit award letters. You decide whats appropriate evidence but bear in mind we can't process your application without enough information.

We need to see a current piece of photo ID for example of Drivers Licence, Passport or Blue Badge. If you are applying for the child and do not have any photo ID in their name then please upload that of a parent or guardian.

If you are completing this application on a mobile device you can take photos of the information we need after you click the 'upload button' by selecting your camera.

We need to have a passport style photo which will be used on your card. If you are applying for the child and do not have any photo ID in their name then please upload that of a parent or guardian.

Upload anything else you think it would be useful for us to see.

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.