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
Email is not a secure way of sending personal data. If you want to send the form electronically, we recommend you use our upload facility. This enables you to send the form securely.
When we have received your form
A member of our contact centre team at Social Care Direct will telephone you to confirm receiving your form.
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. Mary's House
Eastbourne
East Sussex BN21 3UU
Phone: 0345 60 80 191
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.
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.
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