Adult Social Care referral form

Before you complete this form it is important to make sure that you have explored the other options for support. Ensure you have:

  • Spoken to friends and family to see what support they can offer
  • Reviewed the directory of support services for activities and organisations which support your independence
  • Looked for tools and equipment to support you from EquipMe


Make life easier in three simple steps with EquipMe, get impartial advice about tools and equipment to make daily living easier:

  1. Choose a topic
  2. Answer some questions
  3. Get advice

Before you fill in this form

You won't be able to save this form to complete later, so please allow yourself up to five minutes to fill in the form.

Request assessment