We have temporarily suspended applications from the following boroughs, any applications made will be rejected:

Barking and Dagenham
Barnet
Brent
Enfield
Haringey
Harrow
Islington
Kingston upon Thames
All boroughs East London
All boroughs South London

If you experience any trouble with the form or have language difficulties, please contact our AngelBox team on 0204 551 8540 - Option 0.

Are you?

Heavily pregant and due within the next 2 months

Already a parent of a newborn aged 0 to 18 months

Quick Medical & Health Survey About You

We're just collecting basic information about your recent engagements with the GP, Hospital or pharmacy as well as if you've seen our recently updated online health & wellbeing hub which has useful guidance and information on relevant NHS services and more.

Please can you fill out the following questions before continuing with this application.

Your time is appreciated.

When was the last time you visited your GP?

How frequently do you visit the GP per year?

How easy was it to get a GP appointment? (1 star = Terrible - 5 star = Excellent)

Very PoorPoorAverageGoodExcellent

Was the appointment by

How would you rate your current GP? (1 star = Terrible - 5 star = Excellent)

Very PoorPoorAverageGoodExcellent

Why have you given this rating?

When was the last time you visited the hospital?

Was it for a..

How long did you have to wait to be seen by a medical professional?

How would you rate your last hospital visit? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

How would you rate the medical professionals that helped you? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

How would you rate overall ward cleanliness? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

Do you use the NHS App?

Have you used the pharmacy for any of these services recently?

None

Prescription Refill

Information about prescription medicine

Purchase OTC medicine

Information about OTC medicine

Help with a minor health concern

Check BMI & Blood Sugar Level

Contraception support

Travel vaccination

Other

How would you rate your recent pharmacy visit? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

Have you ever used our online health hub to find out about various NHS services?

Have you taken any of the following vaccinations in the last 2 years?

None

Flu vaccine

Pneumococcal vaccine

MMR Vaccine

MenB vaccine

MenACWY vaccine

Hepatitis A vaccine

Hepatitis B vaccine

Covid Vaccine

Covid Booster

Travel Vaccinations

Whooping cough (pertussis) vaccine

Other

Do you remember taking any childhood vaccinations?

Yes

Would you recommend vaccinations to friends & family?

Yes

If you have taken vaccines in the last 2 years did they encounter or recall any side-effects?

Yes

If yes, can you please brief us on the side effects.

Date of last vaccination (if any)

If none, would they like to receive information and guidance on how to book their vaccinations via email or WhatsApp?

Yes

What has prevented them from taking vaccinations in the past?

Quick Medical & Health Survey About Your Child or Children

Your almost there.. Just a few more questions about your child or children's recent engagement with a GP, hospital or pharmacy.

Please can you fill out the following questions before continuing with this application.

Your time is appreciated.

When was the last time your child was seen by a GP?

When was the last time your child was seen by a Health Visitor?

How easy was it to get a GP appointment for your child? (1 star = Terrible - 5 star = Excellent)

Very PoorPoorAverageGoodExcellent

Was the appointment by

How would you rate your current GP? (1 star = Terrible - 5 star = Excellent)

Very PoorPoorAverageGoodExcellent

Why have you given this rating?

When was the last time you visited a hospital for your child?

Was it for a..

How long did you have to wait for your child to be seen by a medical professional?

How would you rate your last hospital visit? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

How would you rate the medical professionals that helped your child? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

How would you rate overall ward cleanliness? (1 star = Terrible - 5 star = Excellent)

TerriblePoorAverageGoodExcellent

Have you used the pharmacy for any of these services recently for your child?

None

Prescription Refill

Information about prescription medicine

Purchase OTC medicine

Information about OTC medicine

Help with a minor health concern

Travel vaccination

Other

Have you used a family centre for help or support with your child?

Did you know about the NHS Healthy Start Scheme

Are you aware of the NHS Start For Life website?

Your child/childrens general vaccination history

Just a quick survey to better understand what vaccinations the children have taken previously.

Has your child/children taken any of these vaccinations?

None

6-in-1 vaccine

Rotavirus vaccine

MenB vaccine

Polio vaccine

Covid Jab

Covid Booster

Pneumococcal vaccine

Hib/MenC vaccine

MMR Vaccine

Children's flu vaccine

4-in-1 pre-school booster vaccine

Hepatitis B vaccine

BCG tuberculosis (TB) vaccine

Has your child or newborn completed 3 doses of their 6 in 1 vaccine? Or do you intend to complete the doses by 16 weeks?

Yes

Has your child or newborn completed 2 doses of their Rotavirus vaccine? Or do you intend to complete the doses by 16 weeks?

Yes

Has your child or newborn completed 2 doses of their MenB vaccine? Or do you intend to complete the doses by 16 weeks?

Yes

Do you have any children between the ages of 18 months to 4 years of age?

Yes

If yes, are they up to date with all their vaccinations?

Yes

Have they or do you intend to complete their MMR vaccination doses as recommended?

Yes

Have they or do you intend to complete their Pneumococcal vaccine doses as recommended?

Yes

Are there any concerns about your children taking vaccinations from a young age?

Was there any visible side-effects after vaccination?

How did you find out about your child/children's vaccinations?

Eligibility Check

This section of the application allows us to check your eligibility for our baby emergency relief package.

As a direct applicant you will be required to provide certain identification documents for you, your partner and baby/babies as part of the assessment process as well as evidence which shows us clear evidence that your currently suffering from financial hardship to ascertain whether your claim for an AngelBox is genuine.

Please confirm you dont reside in any of the boroughs we have temporarily suspended our service

Yes

Please confirm you are able to provide any of the following documents when requested from your assessor.

Identity documents required for you and your partner (Passport, Full Drivers License, Home Office Letters)

Evidence for your baby/babies (MAT B1, Recent hospital letters, birth certificate)

If unemployed - Screenshot of DWP portal if in receipt of benefits

If an asylum seeker - Proof of No Entitlement To Public Funds

3 months bank statements - Must be main account where benefits land

Your Personal Information

Please fill in this section in as much detail as possible. This will help our AngelBox assessors better understand your personal circumstances to make a better decision.

Your partners section will appear based on the information provided.

First Name

Last Name

Please enter your full address

Building Name, House/Flat Number

Street Name

Postal Code

Please enter your primary email address

Please enter your mobile number

Please enter your date of birth

What is your marital status

Your Native Language

Your Employment Status

Your right to live & work in the UK

Your Benefit Status

Main reasons for applying

Have you notified your local authority about your situation?

Will you be able to provide evidence of your financial circumstances?

Partners Section

Please fill in basic information about your partner.

Partners First Name

Partners Last Name

Does your partner live at the same address?

Partners Employment Status

Partners right to live & work in the UK

Your Partners Benefit Status

Baby Information & AngelBox Items

In order to help us assess your AngelBox application, we need basic information about your baby or babies. We also ask that you carefully select the baby essentials and equipment you need in order to better understand your child's needs.

Remember everything in our AngelBox is Brand New & Ready to Use!

All AngelBox items will be discussed in detail during your telephone assessment.

Please make sure your Expected Due Date falls within 2 calendar months or your application will be given a lower priority.

Baby Expected Due Date

How many babies are you expecting

Baby Gender, if known

Please select the baby essentials you need

Nappies (Options)

Wet Wipes Pack (Options)

Bath Tub

Changing Mat

Hooded Towel & Sponge Set

Toiletries (Options)

Clothing (Options)

Cotton Bibs

Blanket or Sleep Bag (Options)

Milk Formula (Options)

Baby Bottles (Options)

Manual Breast Pump

Bottle Brush

Please select the baby equipment you need (stock dependant)

Which hospital will the baby be born in?

If your application is successful,where would you like your AngelBox delivered

Home

Hospital

Your AngelBox will be delivered the week before your pregnancy due date, are their any pregnancy complications or due date issues you would like us to consider as part of the assessment process?

Baby Information & AngelBox Items for 0 to 18 months

Remember everything in our AngelBox is Brand New & Ready to Use!

All AngelBox items will be discussed in detail during your telephone assessment.

Baby Date of Birth

How many babies are you expecting

Baby Gender, if known

Which hospital was the baby born in?

If your application is successful,where would you like your AngelBox delivered

Home

Hospital

Please select the baby essentials you need

Nappies (Options)

Wet Wipes Pack (Options)

Bath Tub

Changing Mat

Hooded Towel & Sponge Set

Toiletries (Options)

Clothing (Options)

Cotton Bibs

Weaning Bib (6 months +)

Blanket or Sleep Bag (Options)

Manual Breast Pump

Aptamil Milk Formula

Cow & Gate Milk Formula

SMA Little Steps Formula

Bonya By Kendamil Formula

Baby Bottles (Standard)

Baby Bottles (Anti-Colic)

Sippy Cup/Training Cup

Food Jars (6 months +)

Porridges (6 months +)

Fruit Pots (6 months +)

Biscuits (6 months +)

Food Package (plate + spoons)

Bottle Brush

Please select the baby equipment you need (stock dependant)

Please describe any allergies or medical issues, our assessors need to know about

Consent & Authorisation

Consent for Basch Helps CIC to process your information and contact you about your application.

Please confirm your Total Household Income meets our eligibility criteria.

I agree to have my personal information be processed for the purpose of assess my application for an AngelBox

I have read and agree to the AngelBox Terms and Conditions and Privacy Policy

AngelBox Parent (Self-Referral) Application

Quick Medical & Health Survey About You

Quick Medical & Health Survey About Your Child or Children

Your child/childrens general vaccination history

Eligibility Check

Your Personal Information

Partners Section

Baby Information & AngelBox Items

Baby Information & AngelBox Items for 0 to 18 months

Consent & Authorisation