Public providers can use this form to ask to close a client service agreement.
You'll need to tell us:
The client's name, Carefirst number and Eclipse ID
Why you are asking to end the agreement
any more information about why the service is ending and any support that may be needed after the service ends
Details of the agreement or agreements you would like to close, including:
service agreement ID
the end date of the agreement
the supplier's name
the type of service
You'll also need to tell us your name, email address and the provider you work for.
We process, analyse and use your data in a range of ways to better understand what our customers need and to improve the way in which the council delivers your services.