Needs Assessment
If you have a disability or health condition which stops you from doing everyday tasks, you may be eligible for our support.
This needs assessment will identify the things you'd like to do that you find difficult.
- The assessment will take about 30 minutes to complete
- You will need to register using an email address. This will allow you to save your form and come back to it at any time.
- When you encounter a question with a red asterisk (*), it means the question is mandatory and must be answered to continue.
What we need you to tell us
The form asks questions about your situation. Use the free text boxes to give full details of what you can and cannot manage.
Next steps
Once you have submitted the form, you will receive an email confirmation. We will review your information and get in touch by phone or email. This form is the start of the assessment process. It will help us to work with you to find out what support you might need.
Find out more
More information is on our website: Who can get help from Adult Social Care (opens in new tab)
You can also contact us for advice. If you need help urgently, phone 0345 60 80 191 (open 8am to 8pm 7 days a week including bank holidays).