Adult with care and support needs

Telling us about your needs

In this form we will ask you questions about your health conditions and/or disabilities, your home and your financial situation. We will also ask questions about your care needs, some examples are:

  • Your ability to prepare meals or eat and drink without help from others.
  • Your ability to wash, get dressed or undressed without help from others.
  • Being safe in your home

These questions will start the assessment process and help us work out with you what support you might need.
This may include information and advice specific to your needs about how to access community support, self-funded services and/or council funded care services.

Who can use this form?

Anyone can use this form to tell us about someone's care and support needs. You can do this for yourself or on behalf of someone you know with their consent.

If you are completing this form on behalf of someone else, please remember the questions relate to their care and support needs. We will also contact them in the first instance unless it is not appropriate to do so.

This form can also be used by professionals such as care or support workers.

If your needs are urgent, please call us on 0345 60 80 91. The same number can be used to contact the Emergency Duty Service or leave a message outside of office hours.

What will I need to complete this form?

To complete this form you will need to have the following to hand:

  • Your email address, you will not be able to submit a form without an email address
  • Details of anyone you would like to be involved with your assessment
  • If you are completing the form on behalf of someone else you will need to know details of the person you care for; name, address and date for birth.
  • Please complete the form as honestly, accurately and fully as possible. The form will guide you to additional questions where appropriate.

How long will it take?

The length of time it will take depends on the amount of information you need to provide. For complex circumstances it could take up to 30 minutes to complete the form. Please note, for security reasons if there has been no activity for 15 minutes your session will expire. You can save your form at any point using the Save for Later button.
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Translating Adult Social Care Online pages

Whilst it is possible to translate these pages using Google Translate East Sussex County Council is not responsible for this service and cannot guarantee the accuracy of the translations available. Please be aware that Google Translate may affect the forms links and functions.

If you require translation services to make your application, please contact Social Care Direct on 0345 60 80 191. Or click the button below to access our Translation Service page.
Adult Social Care Translation Service