Why give us these facts?

To help us tailor advice and financial solutions that are specific to your needs and circumstances - or to those of the person who needs care - we ask you to complete this Fact File. The confidential information you supply enables us to understand the unique circumstances and requirements, and give you appropriate advice.

You may have questions or need help when completing the Fact File. If so, call us on 01582 794967 during normal office hours or email us at: care@carefeesplanning.com

What happens next?

Once you have completed every section of the Fact File as fully as possible, check your answers and press the 'send' button at the base of the form.

Once we have all the Facts, we can prepare a report for you and arrange an appointment to talk through the various options available.

Prefer to hand write?

If you would prefer to print out a Fact File and write your answers by hand, you can download a PDF by clicking here. Or if you would rather we posted a brochure and a pre-printed Fact File to you, please fill in the contact details above (name, address, postcode and telephone numbers) and press the 'send' button at the bottom of the form.

(* indicates required field)

Online Fact File

There is no obligation and our initial consultation is free. We will contact you by telephone to discuss your specific circumstances in more detail, before presenting a report tailored to your needs. After that, we can talk you through the options, at a time and place that suits you. Take your next step with the support and expertise of Care Fees Planning, and make an informed decision that solves the problems of paying for care.

Contact Details

Personal details of the person who needs care

Is a Power of Attorney in place?

If yes, please give the name(s) of those holding Enduring Power of Attorney Mr/Mrs/Miss/Other

Has it been registered with Court of Protection?

If no, are you applying for a Deputyship?

Health details of the person who needs care

We need to know the severity of any existing medical condition or lifestyle problems, in order to assess suitable courses of action.

Present physical and mental health
(eg mild/severe arthritis, disability, dementia, short term memory loss etc.)

Brief medical history (include current medications)

(eg heart problem, stroke, operations, cancer, Parkinson's Disease etc)


Activities of Daily Living - please advise whether independent, or assistance required







Toilet use




Details of care needed

Details of preferred care home

Date of admission to care home (if known)

Is care required already?

Financial details of the person who needs care (state whether weekly / 4 weeks / monthly / annually )

Existing / anticipated retirement income

Capital and savings


Mortgage on property?

If yes, please state amount

Is property owned?

If joint Tenants / Tenants in Common, please give name(s) of joint owners.
Mr / Mrs / Miss / Other

Care priorities and other relevant details

Tell us of any concerns, objectives and priorities and we can better advice on
individual needs eg "I want to leave an inheritance for my children".
Is there anything else we need to know?

We will not pass your details to companies outside Brownlow Wealth Management Ltd and St. James's Place Wealth Management plc without your consent. If you are happy to receive offers from carefully selected organisations by phone, email or post, please click here

Data Protection Act 1998

The information recorded above may be retained on computer for reference purposes and will be held in accordance with the above act. You agree that the personal information held by Brownlow Wealth Management may be disclosed on a confidential basis. You also agree that this information may be transferred electronically, e.g. email and you agree that ourselves, or any such third party, may contact you in the future by any means of communication which we consider appropriate at the time.