Adult Self Assessment Referral

If you want to discuss your needs with someone or require further information, you can make a referral to the council – this usually takes around 10-15 mins to complete.

When making a referral to adult social care, we will ask you to provide your personal details including how we can contact you. You will also have the opportunity to tell us a bit more about the areas in which you said you are not able to manage independently.


If you do not want us to share specific information with certain people or organisations, please select the "Yes, with limitations" option and provide the relevant details in the box

Personal details


Contact Details