{"id":358,"date":"2026-04-16T22:45:30","date_gmt":"2026-04-16T22:45:30","guid":{"rendered":"https:\/\/www.hzelectrical.co.za\/Norvia\/?page_id=358"},"modified":"2026-09-16T13:22:44","modified_gmt":"2026-09-16T13:22:44","slug":"request-care","status":"publish","type":"page","link":"https:\/\/www.hzelectrical.co.za\/Norvia\/request-care\/","title":{"rendered":"Request Care"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; background_enable_color=&#8221;off&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_direction=&#8221;90deg&#8221; background_color_gradient_stops=&#8221;rgba(13,47,92,0.89) 0%|rgba(1,68,163,0.87) 59%|rgba(12,113,195,0) 100%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_image=&#8221;https:\/\/www.hzelectrical.co.za\/Norvia\/wp-content\/uploads\/2026\/04\/Domiciliary-care-Leeds-Banner.webp&#8221; custom_padding=&#8221;70px||70px||true|false&#8221; custom_padding_tablet=&#8221;40px||40px||true|false&#8221; custom_padding_phone=&#8221;30px||30px||true|false&#8221; bottom_divider_style=&#8221;curve2&#8243; bottom_divider_color=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; bottom_divider_height=&#8221;36px&#8221; bottom_divider_repeat=&#8221;1x&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22bottom_divider_color%22%93}&#8221;][et_pb_row column_structure=&#8221;2_3,1_3&#8243; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;2_3&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#FFFFFF&#8221; header_font=&#8221;&#8211;et_global_heading_font|600|||||||&#8221; header_text_color=&#8221;#FFFFFF&#8221; header_font_size=&#8221;50px&#8221; header_2_font=&#8221;|800|||||||&#8221; header_2_text_color=&#8221;#FFFFFF&#8221; header_2_font_size=&#8221;50px&#8221; header_2_letter_spacing=&#8221;1px&#8221; width=&#8221;100%&#8221; header_font_size_tablet=&#8221;5vw&#8221; header_font_size_phone=&#8221;6vw&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; header_2_font_size_tablet=&#8221;5vw&#8221; header_2_font_size_phone=&#8221;7vw&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>Request Domicilliary Care in Walsall &amp; the West Midlands<\/h1>\n<p>Taking the first step towards arranging care can feel daunting, but it does not need to be. Completing this form is simply the first step in starting a conversation with us. It does not commit you or your loved one to receiving any services from Norvia Care Solutions.[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; custom_padding=&#8221;50px||50px||true|false&#8221; custom_padding_tablet=&#8221;40px||40px||true|false&#8221; custom_padding_phone=&#8221;30px||30px||true|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22background_color%22%93}&#8221;][et_pb_row column_structure=&#8221;1_4,1_4,1_4,1_4&#8243; use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.7&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FFFFFF&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;20px|20px|20px|20px|true|true&#8221; border_radii=&#8221;on|20px|20px|20px|20px&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;gcid-secondary-color&#8221; global_colors_info=&#8221;{%22gcid-secondary-color%22:%91%22border_color_all%22%93}&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;&#8211;et_global_body_font||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.3em&#8221; header_3_font=&#8221;Quicksand|||on|||||&#8221; header_3_text_color=&#8221;gcid-secondary-color&#8221; header_3_font_size=&#8221;14px&#8221; header_3_line_height=&#8221;0.8em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93,%22gcid-secondary-color%22:%91%22header_3_text_color%22%93}&#8221;]<\/p>\n<h3><strong>Who can use this form?<\/strong><\/h3>\n<p>Anyone looking for support for themselves or a loved one across Walsall and the West Midlands.[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;&#8211;et_global_body_font||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.3em&#8221; header_3_font=&#8221;Quicksand|||on|||||&#8221; header_3_text_color=&#8221;gcid-secondary-color&#8221; header_3_font_size=&#8221;14px&#8221; header_3_line_height=&#8221;0.8em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93,%22gcid-secondary-color%22:%91%22header_3_text_color%22%93}&#8221;]<\/p>\n<h3><strong>How long does it take?<\/strong><\/h3>\n<p>Approximately 5\u201310 minutes.[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;&#8211;et_global_body_font||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.3em&#8221; header_3_font=&#8221;Quicksand|||on|||||&#8221; header_3_text_color=&#8221;gcid-secondary-color&#8221; header_3_font_size=&#8221;14px&#8221; header_3_line_height=&#8221;0.8em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93,%22gcid-secondary-color%22:%91%22header_3_text_color%22%93}&#8221;]<\/p>\n<h3><strong>What happens next?<\/strong><\/h3>\n<p>A member of our team will contact you to discuss your needs.[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;&#8211;et_global_body_font||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.3em&#8221; header_3_font=&#8221;Quicksand|||on|||||&#8221; header_3_text_color=&#8221;gcid-secondary-color&#8221; header_3_font_size=&#8221;14px&#8221; header_3_line_height=&#8221;0.8em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93,%22gcid-secondary-color%22:%91%22header_3_text_color%22%93}&#8221;]<\/p>\n<h3><strong>Is there any obligation?<\/strong><\/h3>\n<p>No. Your enquiry is confidential and without obligation.[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;gcid-8277d4aa-406b-4369-bf1c-55c9deb55f60&#8243; custom_padding=&#8221;70px||70px||true|false&#8221; locked=&#8221;off&#8221; 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global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22title_text_color%22,%22title_text_color%22%93,%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22title_text_color%22%93}&#8221;][\/et_pb_heading][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;2_5,3_5&#8243; use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;6px||0px|||&#8221; custom_css_main_element=&#8221;align-items:center;&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;2_5&#8243; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image src=&#8221;https:\/\/www.hzelectrical.co.za\/Norvia\/wp-content\/uploads\/2026\/04\/What-Happens-After-You-Request-Care.webp&#8221; alt=&#8221;A member of ABR Grace Solutions care coordination discussing  Users needs.&#8221; title_text=&#8221;What Happens After You Request Care&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; border_radii=&#8221;on|15px|15px|15px|15px&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][\/et_pb_column][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_blurb title=&#8221;Complete the form&#8221; image=&#8221;https:\/\/www.hzelectrical.co.za\/Norvia\/wp-content\/uploads\/2026\/08\/number-one-icon.png&#8221; icon_placement=&#8221;left&#8221; content_max_width=&#8221;100%&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;&#8211;et_global_heading_font|500|||||||&#8221; header_text_color=&#8221;gcid-primary-color&#8221; body_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; background_color=&#8221;gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe&#8221; image_icon_custom_margin=&#8221;10px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; child_filter_hue_rotate=&#8221;137deg&#8221; child_filter_saturate=&#8221;111%&#8221; child_filter_brightness=&#8221;52%&#8221; animation_style=&#8221;slide&#8221; border_radii=&#8221;on|15px|15px|15px|15px&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22header_text_color%22%93,%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22body_text_color%22%93,%22gcid-secondary-color%22:%91%22icon_color%22%93,%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22border_color_all%22%93,%22gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe%22:%91%22background_color%22%93}&#8221;]Tell us a little about the person needing support.[\/et_pb_blurb][et_pb_blurb title=&#8221;We review your enquiry&#8221; image=&#8221;https:\/\/www.hzelectrical.co.za\/Norvia\/wp-content\/uploads\/2026\/08\/number-two-icon.png&#8221; icon_placement=&#8221;left&#8221; content_max_width=&#8221;100%&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;&#8211;et_global_heading_font|500|||||||&#8221; header_text_color=&#8221;gcid-primary-color&#8221; body_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; background_color=&#8221;gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe&#8221; image_icon_custom_margin=&#8221;10px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; child_filter_hue_rotate=&#8221;137deg&#8221; child_filter_saturate=&#8221;111%&#8221; child_filter_brightness=&#8221;52%&#8221; animation_style=&#8221;slide&#8221; border_radii=&#8221;on|15px|15px|15px|15px&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22header_text_color%22,%22header_text_color%22,%22header_text_color%22,%22header_text_color%22%93,%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22body_text_color%22,%22body_text_color%22%93,%22gcid-secondary-color%22:%91%22icon_color%22,%22icon_color%22%93,%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22border_color_all%22%93,%22gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe%22:%91%22background_color%22%93}&#8221;]Our Walsall-based team reviews the details you share.[\/et_pb_blurb][et_pb_blurb title=&#8221;We contact you&#8221; image=&#8221;https:\/\/www.hzelectrical.co.za\/Norvia\/wp-content\/uploads\/2026\/08\/number-three-icon.png&#8221; icon_placement=&#8221;left&#8221; content_max_width=&#8221;100%&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;&#8211;et_global_heading_font|500|||||||&#8221; header_text_color=&#8221;gcid-primary-color&#8221; 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global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22header_text_color%22,%22header_text_color%22,%22header_text_color%22,%22header_text_color%22%93,%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22body_text_color%22,%22body_text_color%22%93,%22gcid-secondary-color%22:%91%22icon_color%22,%22icon_color%22%93,%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22border_color_all%22%93,%22gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe%22:%91%22background_color%22%93}&#8221;]We call or email to talk through your situation and answer questions.[\/et_pb_blurb][et_pb_blurb title=&#8221;Arrange an assessment&#8221; image=&#8221;https:\/\/www.hzelectrical.co.za\/Norvia\/wp-content\/uploads\/2026\/08\/number-four-icon.png&#8221; icon_placement=&#8221;left&#8221; content_max_width=&#8221;100%&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;&#8211;et_global_heading_font|500|||||||&#8221; header_text_color=&#8221;gcid-primary-color&#8221; body_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; background_color=&#8221;gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe&#8221; image_icon_custom_margin=&#8221;10px||||false|false&#8221; custom_padding=&#8221;15px|15px|15px|15px|true|true&#8221; child_filter_hue_rotate=&#8221;137deg&#8221; child_filter_saturate=&#8221;111%&#8221; child_filter_brightness=&#8221;52%&#8221; animation_style=&#8221;slide&#8221; border_radii=&#8221;on|15px|15px|15px|15px&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22header_text_color%22,%22header_text_color%22,%22header_text_color%22,%22header_text_color%22%93,%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22body_text_color%22,%22body_text_color%22%93,%22gcid-secondary-color%22:%91%22icon_color%22,%22icon_color%22%93,%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22border_color_all%22%93,%22gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe%22:%91%22background_color%22%93}&#8221;]If appropriate, we arrange a friendly assessment at a time that suits you.[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; background_enable_image=&#8221;off&#8221; custom_padding=&#8221;70px||70px||true|false&#8221; custom_padding_tablet=&#8221;40px||40px||true|false&#8221; custom_padding_phone=&#8221;30px||30px||true|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22background_color%22%93}&#8221;][et_pb_row use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;6px||0px|||&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_heading title=&#8221;Request Care Form&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; title_level=&#8221;h2&#8243; title_font=&#8221;&#8211;et_global_heading_font|600|||||||&#8221; title_text_color=&#8221;gcid-primary-color&#8221; title_font_size=&#8221;36px&#8221; title_font_size_tablet=&#8221;4vw&#8221; title_font_size_phone=&#8221;5vw&#8221; title_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22title_text_color%22%93}&#8221;][\/et_pb_heading][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.4em&#8221; header_font=&#8221;&#8211;et_global_heading_font|500|||||||&#8221; header_text_color=&#8221;gcid-primary-color&#8221; background_color=&#8221;gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe&#8221; custom_padding=&#8221;30px|30px|30px|30px|true|true&#8221; animation_style=&#8221;slide&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; border_radii=&#8221;on|15px|15px|15px|15px&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22header_text_color%22%93,%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22body_text_color%22,%22text_text_color%22%93,%22gcid-secondary-color%22:%91%22icon_color%22%93,%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22border_color_all%22%93,%22gcid-acff8228-7783-42d9-b9d7-ba2f45bd9ffe%22:%91%22background_color%22%93}&#8221;]<\/p>\n<div class=\"forminator-ui forminator-custom-form forminator-custom-form-575 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-575\" data-uid=\"6accff615de76\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-575\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-575 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"575\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6accff615de76\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-first-name-1_6accff615de76\" id=\"forminator-field-first-name-1_6accff615de76-label\" class=\"forminator-label\">First Name<\/label><input type=\"text\" name=\"name-1-first-name\" placeholder=\"\" id=\"forminator-field-first-name-1_6accff615de76\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-6\"><div class=\"forminator-field\"><label for=\"forminator-field-last-name-1_6accff615de76\" id=\"forminator-field-last-name-1_6accff615de76-label\" class=\"forminator-label\">Last Name<\/label><input type=\"text\" name=\"name-1-last-name\" placeholder=\"\" id=\"forminator-field-last-name-1_6accff615de76\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6accff615de76\" id=\"forminator-field-email-1_6accff615de76-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6accff615de76\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6accff615de76\" id=\"forminator-field-phone-1_6accff615de76-label\" class=\"forminator-label\">Contact Phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6accff615de76\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"disabled\" data-country=\"gb\" data-validation=\"international\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Date of Birth <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-575__field--date-1-day_6accff615de76\" id=\"forminator-field-575__field--date-1-day_6accff615de76-label\" class=\"forminator-label\">Day<\/label><select name=\"date-1-day\" id=\"forminator-field-575__field--date-1-day_6accff615de76\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-575__field--date-1-day_6accff615de76-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select day<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><\/div><\/div><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-575__field--date-1-month_6accff615de76\" id=\"forminator-field-575__field--date-1-month_6accff615de76-label\" class=\"forminator-label\">Month<\/label><select name=\"date-1-month\" id=\"forminator-field-575__field--date-1-month_6accff615de76\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-575__field--date-1-month_6accff615de76-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select month<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><\/div><\/div><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-575__field--date-1-year_6accff615de76\" id=\"forminator-field-575__field--date-1-year_6accff615de76-label\" class=\"forminator-label\">Year<\/label><select name=\"date-1-year\" id=\"forminator-field-575__field--date-1-year_6accff615de76\" class=\"forminator-select2\" data-format=\"dd\/mm\/yy\" data-parent=\"date-1\" aria-labelledby=\"forminator-field-575__field--date-1-year_6accff615de76-label\" data-default-value=\"\"><option value=\"\" selected=\"selected\">Select Year<\/option><option value=\"2126\" >2126<\/option><option value=\"2125\" >2125<\/option><option value=\"2124\" >2124<\/option><option value=\"2123\" >2123<\/option><option value=\"2122\" >2122<\/option><option value=\"2121\" >2121<\/option><option value=\"2120\" >2120<\/option><option value=\"2119\" >2119<\/option><option value=\"2118\" >2118<\/option><option value=\"2117\" >2117<\/option><option value=\"2116\" >2116<\/option><option value=\"2115\" >2115<\/option><option value=\"2114\" >2114<\/option><option value=\"2113\" >2113<\/option><option value=\"2112\" >2112<\/option><option value=\"2111\" >2111<\/option><option value=\"2110\" >2110<\/option><option value=\"2109\" >2109<\/option><option value=\"2108\" >2108<\/option><option value=\"2107\" >2107<\/option><option value=\"2106\" >2106<\/option><option value=\"2105\" >2105<\/option><option value=\"2104\" >2104<\/option><option value=\"2103\" >2103<\/option><option value=\"2102\" >2102<\/option><option value=\"2101\" >2101<\/option><option value=\"2100\" >2100<\/option><option value=\"2099\" >2099<\/option><option value=\"2098\" >2098<\/option><option value=\"2097\" >2097<\/option><option value=\"2096\" >2096<\/option><option value=\"2095\" >2095<\/option><option value=\"2094\" >2094<\/option><option value=\"2093\" >2093<\/option><option value=\"2092\" >2092<\/option><option value=\"2091\" >2091<\/option><option value=\"2090\" >2090<\/option><option value=\"2089\" >2089<\/option><option value=\"2088\" >2088<\/option><option value=\"2087\" >2087<\/option><option value=\"2086\" >2086<\/option><option value=\"2085\" >2085<\/option><option value=\"2084\" >2084<\/option><option value=\"2083\" >2083<\/option><option value=\"2082\" >2082<\/option><option value=\"2081\" >2081<\/option><option value=\"2080\" >2080<\/option><option value=\"2079\" >2079<\/option><option value=\"2078\" >2078<\/option><option value=\"2077\" >2077<\/option><option value=\"2076\" >2076<\/option><option value=\"2075\" >2075<\/option><option value=\"2074\" >2074<\/option><option value=\"2073\" >2073<\/option><option value=\"2072\" >2072<\/option><option value=\"2071\" >2071<\/option><option value=\"2070\" >2070<\/option><option value=\"2069\" >2069<\/option><option value=\"2068\" >2068<\/option><option value=\"2067\" >2067<\/option><option value=\"2066\" >2066<\/option><option value=\"2065\" >2065<\/option><option value=\"2064\" >2064<\/option><option value=\"2063\" >2063<\/option><option value=\"2062\" >2062<\/option><option value=\"2061\" >2061<\/option><option value=\"2060\" >2060<\/option><option value=\"2059\" >2059<\/option><option value=\"2058\" >2058<\/option><option value=\"2057\" >2057<\/option><option value=\"2056\" >2056<\/option><option value=\"2055\" >2055<\/option><option value=\"2054\" >2054<\/option><option value=\"2053\" >2053<\/option><option value=\"2052\" >2052<\/option><option value=\"2051\" >2051<\/option><option value=\"2050\" >2050<\/option><option value=\"2049\" >2049<\/option><option value=\"2048\" >2048<\/option><option value=\"2047\" >2047<\/option><option value=\"2046\" >2046<\/option><option value=\"2045\" >2045<\/option><option value=\"2044\" >2044<\/option><option value=\"2043\" >2043<\/option><option value=\"2042\" >2042<\/option><option value=\"2041\" >2041<\/option><option value=\"2040\" >2040<\/option><option value=\"2039\" >2039<\/option><option value=\"2038\" >2038<\/option><option value=\"2037\" >2037<\/option><option value=\"2036\" >2036<\/option><option value=\"2035\" >2035<\/option><option value=\"2034\" >2034<\/option><option value=\"2033\" >2033<\/option><option value=\"2032\" >2032<\/option><option value=\"2031\" >2031<\/option><option value=\"2030\" >2030<\/option><option value=\"2029\" >2029<\/option><option value=\"2028\" >2028<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6accff615de76-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6accff615de76-label\" class=\"forminator-label\">Type of Care Needed <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6accff615de76-label\" for=\"forminator-field-checkbox-1-1-6accff615de76\" class=\"forminator-checkbox\" title=\"Autism Support\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Autism-Support\" id=\"forminator-field-checkbox-1-1-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-1-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Autism Support<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6accff615de76-label\" for=\"forminator-field-checkbox-1-2-6accff615de76\" class=\"forminator-checkbox\" title=\"Learning Disability Support\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Learning-Disability-Support\" id=\"forminator-field-checkbox-1-2-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-2-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Learning Disability Support<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6accff615de76-label\" for=\"forminator-field-checkbox-1-3-6accff615de76\" class=\"forminator-checkbox\" title=\"Physical Disability Support\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Physical-Disability-Support\" id=\"forminator-field-checkbox-1-3-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-3-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Physical Disability Support<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6accff615de76-label\" for=\"forminator-field-checkbox-1-4-6accff615de76\" class=\"forminator-checkbox\" title=\"General Living Assistance\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"General-Living-Assistance\" id=\"forminator-field-checkbox-1-4-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-4-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">General Living Assistance<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6accff615de76-label\" for=\"forminator-field-checkbox-1-5-6accff615de76\" class=\"forminator-checkbox\" title=\"Companionship &amp; Social Support\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Companionship-Social-Support\" id=\"forminator-field-checkbox-1-5-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-5-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Companionship &amp; Social Support<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6accff615de76-label\" for=\"forminator-field-checkbox-1-6-6accff615de76\" class=\"forminator-checkbox\" title=\"Dementia Care\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Dementia-Care\" id=\"forminator-field-checkbox-1-6-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-6-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dementia Care<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6accff615de76-label\" for=\"forminator-field-checkbox-1-7-6accff615de76\" class=\"forminator-checkbox\" title=\"Overnight Care\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Overnight-Care\" id=\"forminator-field-checkbox-1-7-6accff615de76\" aria-labelledby=\"forminator-field-checkbox-1-7-6accff615de76-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overnight Care<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6accff615de76\" id=\"forminator-field-textarea-1_6accff615de76-label\" class=\"forminator-label\">Additional Details or Special Requests<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6accff615de76\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\" style=\"margin: 0;\"><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6accff615de76\" id=\"forminator-field-consent-1_6accff615de76-label\" class=\"forminator-label\">Consent <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6accff615de76__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6accff615de76\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6accff615de76-label\" aria-describedby=\"forminator-field-consent-1_6accff615de76__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6accff615de76__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>Yes, I agree with the <a href=\"https:\/\/www.hzelectrical.co.za\/Norvia\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">privacy policy<\/a> and <a href=\"\/terms-and-conditions\/\" target=\"_blank\" rel=\"noopener\">terms and conditions<\/a>.<\/p><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Apply Now<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"eea8c40ccd\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/Norvia\/wp-json\/wp\/v2\/pages\/358\" \/><input type=\"hidden\" name=\"form_id\" value=\"575\"><input type=\"hidden\" name=\"page_id\" value=\"358\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.hzelectrical.co.za\/Norvia\/request-care\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;70px||70px||true|false&#8221; custom_padding_tablet=&#8221;40px||40px||true|false&#8221; custom_padding_phone=&#8221;30px||30px||true|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;6px||0px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_heading title=&#8221;Information for Professional Referrers&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; title_level=&#8221;h2&#8243; title_font=&#8221;&#8211;et_global_heading_font|600|||||||&#8221; title_text_color=&#8221;gcid-primary-color&#8221; title_font_size=&#8221;36px&#8221; title_font_size_tablet=&#8221;4vw&#8221; title_font_size_phone=&#8221;5vw&#8221; title_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22title_text_color%22%93}&#8221;][\/et_pb_heading][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.4em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p>If you are a social worker, care coordinator, GP, hospital discharge planner, or local authority commissioner <strong>looking to refer a client to Norvia Care Solutions<\/strong>, we welcome your referral. We work collaboratively with health and social care professionals across Walsall and West Midlands to ensure seamless, timely, and effective care delivery.<\/p>\n<p>For professional referrals, please <strong>complete the form above<\/strong> or contact us directly. We can accommodate <strong>urgent and fast-track referrals<\/strong> and are responsive to complex care needs.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;gcid-8237ef3f-badf-4adb-89b6-2d42a0872202&#8243; custom_padding=&#8221;70px||70px||true|false&#8221; custom_padding_tablet=&#8221;40px||40px||true|false&#8221; custom_padding_phone=&#8221;30px||30px||true|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{%22gcid-8237ef3f-badf-4adb-89b6-2d42a0872202%22:%91%22background_color%22%93}&#8221;][et_pb_row use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;6px||0px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_heading title=&#8221;Funding Your Domiciliary Care&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; title_level=&#8221;h2&#8243; title_font=&#8221;&#8211;et_global_heading_font|600|||||||&#8221; title_text_color=&#8221;gcid-primary-color&#8221; title_font_size=&#8221;36px&#8221; title_font_size_tablet=&#8221;4vw&#8221; title_font_size_phone=&#8221;5vw&#8221; title_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-primary-color%22:%91%22title_text_color%22%93}&#8221;][\/et_pb_heading][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.4em&#8221; custom_margin=&#8221;||0px|||&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p><span>We understand that the cost of care is an important consideration. Domiciliary care in Walsall and West Midlands can be funded in several ways:<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_5,1_5,1_5,1_5,1_5&#8243; use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;||||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;20px|20px|20px|20px|true|true&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; border_width_all=&#8221;2px&#8221; border_color_all=&#8221;gcid-secondary-color&#8221; global_colors_info=&#8221;{%22gcid-secondary-color%22:%91%22border_color_all%22%93}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.5em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p><strong>Local Authority Funding<\/strong> \u2014 Following a needs assessment by Walsall and West Midlands <\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;20px|20px|20px|20px|true|true&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; border_width_all=&#8221;2px&#8221; border_color_all=&#8221;gcid-secondary-color&#8221; global_colors_info=&#8221;{%22gcid-secondary-color%22:%91%22border_color_all%22%93}&#8221;][et_pb_text _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.5em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p><strong>NHS Continuing Healthcare (CHC)<\/strong> \u2014 For individuals with a primary health need<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;20px|20px|20px|20px|true|true&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; border_width_all=&#8221;2px&#8221; border_color_all=&#8221;gcid-secondary-color&#8221; global_colors_info=&#8221;{%22gcid-secondary-color%22:%91%22border_color_all%22%93}&#8221;][et_pb_text _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.5em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p><strong>Direct Payments<\/strong> \u2014 Giving you control over how your care budget is spent<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;20px|20px|20px|20px|true|true&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; border_width_all=&#8221;2px&#8221; border_color_all=&#8221;gcid-secondary-color&#8221; global_colors_info=&#8221;{%22gcid-secondary-color%22:%91%22border_color_all%22%93}&#8221;][et_pb_text _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.5em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p><strong>Self-Funding \/ Private Pay<\/strong> \u2014 Paying privately for the care you choose<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_5&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;20px|20px|20px|20px|true|true&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; border_width_all=&#8221;2px&#8221; border_color_all=&#8221;gcid-secondary-color&#8221; global_colors_info=&#8221;{%22gcid-secondary-color%22:%91%22border_color_all%22%93}&#8221;][et_pb_text _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.5em&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p><strong>Combination Funding<\/strong> \u2014 A mix of the above<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row use_custom_gutter=&#8221;on&#8221; make_equal=&#8221;on&#8221; _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; max_width=&#8221;1580px&#8221; custom_padding=&#8221;6px||0px|||&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.8&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;gcid-69409459-10fb-4c25-ad28-390b52007d24&#8243; text_line_height=&#8221;1.4em&#8221; custom_margin=&#8221;||0px|||&#8221; custom_padding=&#8221;1px|||||&#8221; text_font_size_tablet=&#8221;2vw&#8221; text_font_size_phone=&#8221;3.6vw&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; text_line_height_tablet=&#8221;1.5em&#8221; text_line_height_phone=&#8221;1.4em&#8221; text_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{%22gcid-69409459-10fb-4c25-ad28-390b52007d24%22:%91%22text_text_color%22%93}&#8221;]<\/p>\n<p>We are happy to discuss funding options and help guide you through the process.<span style=\"color: #ffffff;\"> <strong><a href=\"\/contact-us\" data-mce-fragment=\"1\" style=\"color: #ffffff;\">Contact us<\/a>\u200b<\/strong><\/span> for more information.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Request Domicilliary Care in Walsall &amp; the West Midlands Taking the first step towards arranging care can feel daunting, but it does not need to be. Completing this form is simply the first step in starting a conversation with us. 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