Request a needs assessment

If you have a health problem or disability that makes it hard to do daily activities, we may be able to help you.

What you need to know:

  • This form is the start of the assessment process. It will help us to find out what support you may need.
  • Care and support services are not free. Most people will pay some money towards their care costs. The amount you pay is based on what you can afford.
  • The form 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.
  • If a question has a red asterisk (*) it means it is mandatory and you must answer it to continue.
  • If a question has a blue question mark (?). Select this for related help text.

What we will ask you:

  • How well you manage with areas of day-to-day life
  • Questions that help us decide if you might qualify for support from us. After this step, you can choose to continue the form, even if it is not likely you will get support from us. We might contact you to offer advice.
  • If you continue the form, you will answer detailed questions about your situation.

Next steps

After you submit the form, you will receive an email confirmation. We will review your information and get in touch by phone or email.


Start form

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).

Click or tap the rating which best represents your experience

Was this page helpful?

Click or tap the rating which best represents your experience.