Use this form if you, or the person you are completing this form for, live in Surrey and have care and support needs. It will help you find out what support you could get from the council. This could include information and advice to help you stay independent, safe and well.
It asks you about how your care and support needs affect:
- your health and wellbeing
- your ability to do the things that are most important to you
You can complete the form for:
- yourself
- someone else with their consent
If you're filling the form out for someone else we will contact them in the first instance unless they are not able to have a conversation with us.
Before you can send us your self assessment, you will need to register and login. This means we can keep your information in a secure place and you wont have to repeat information at a later date.
The form should take about 20 minutes to complete. You don't have to answer all questions, but you must fill out any marked with an asterisk*.
If you have concerns about
abuse and neglect consider using our safeguarding self referral form instead.
Find further information about our
assessment process including
paying for care.