1. At home
  2. Extra services
  3. ExtraCare
  4. ExtraCare Registration Form

ExtraCare Registration Form

If you have a problem filling in this form, you can print it out (PDF) and post it to us or we can help you register. Please phone us on 0845 746 1100. Dial 18001 first if you have hearing or speech difficulties.

We consider the protection of your privacy to be of great importance. Please read our privacy statement to understand how we may use your personal information.

  1. Personal details
  2. Bills and reminders
Personal details
  1. United Utilities account number
    Account number placement on your bill
  6. Type of property
  13. To ensure that we register you for the correct services, please tick the boxes that best describe your circumstances





  14. Do you have a serious medical illness? Required