Find out if we can help arrange your care

Use this form to:  

  • check if you're eligible for our help to arrange your care 

  • request a care needs assessment if you need one 

  • find other services and support that could help you

How it works 

The form will ask you questions based on the UK’s laws about care.  

Based on your answers, it'll either suggest you're: 

  • likely to be eligible and prompt you to request a care assessment
  • not likely to be eligible and point you to other sources of help 

We'll only see your answers if you decide to request a care assessment.  

You can still request a care assessment even if you’re not likely to be eligible, as this is your legal right. 

Completing the form for someone else 

You can complete this form for someone else, like a friend or family member.  

If you do this, you should: 

  • get the person’s consent to share their information, unless they cannot give it
  • answer each question from their perspective, as if you are them 

You can also ask for support with caring for someone if you need support for yourself.  

If you need urgent help  

If someone’s life or safety is in danger right now, call 999 or go to your nearest A&E department.   

For urgent mental health support, call the NHS Oxleas 24-hour crisis line on 0800 330 8590.   

Start the form

Start

What will happen next 

If you request a care assessment using this form, we’ll aim to contact you within 5 days.  

This is to: 

  • find out more about your situation
  • explain how the care assessment process works
  • refer you to other services that might be able to help you 

You're likely to need to pay for at least some of your care. Find out how we work out how much you need to pay 

If you need help with this form  

How we use your data  

To find out how we use, store and protect the information you give us, read our data protection privacy notice.