This form has been created to help us understand how your caring role affects your health and wellbeing and your ability to do the things that are most important to you.
The questions in this form focus on
- how your role as a carer affects your ability to manage daily activities.
- providing you with relevant advice and information.
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 won't 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.
See our
webpages for information about the support that is available for carers in Surrey.