Apply for adult services
Please complete this form if you, a friend or relative wants to be assessed for the adult services we provide. If you are applying on behalf of someone else, you must have their consent before completing the form.
We do not recommend that you email this form to us
it contains personal information and email is not a secure way of sending data. If you want to send the form electronically, we recommend you use our upload facility which enables you to send the form in a secure way.
When we have received your form
a member of our contact centre team at Social Care Direct will telephone you.
If you need to contact us
If you would like to talk to someone about your application, or if you wish to apply by phone, please contact Social Care Direct as follows:
Social Care Direct (Adult Services)
St. Mark's House, 14 Upperton Road
Eastbourne
East Sussex BN21 1EP
Tel: 0845 6080191
Fax: 01323 466567
Email social care direct
Guidance notes
We recommend that you read the following before you complete this form:
Guidance for carers
if you are a carer, and require a 'carers assessment' to address your social care needs, you only need complete Sections A, B and C on this form. In Section C make sure you write 'Carers Assessment' so we can process more efficiently.
This RTF form is an accessible version of the Background Information & Contact Assessment form. It may look slightly different and takes up more pages, but collects the same data. It may take you longer to complete.
Your personal details are protected when using our online forms. Read our privacy statement.
This form is available in Adobe Acrobat (PDF) format and Rich Text format. If these don't work for you, we can help you with viewing files.
