Tell us about your support needs

Getting started

Please complete our online wellbeing questionnaire. It may be for you, or you may be filling it in on behalf of someone else. Either way, you will find useful advice or information that will help you or them live a healthier, safer and happier life.

When you have finished the questionnaire we will tell you whether you may be eligible for extra help. If this is the case, and you would like to be considered for that extra help, you will need to register. You will then get an automatic receipt and we will be in touch within five working days.

You need to complete this form before we can carry out a full Care Act 2014 assessment.

How to navigate

Click on the numbered sections on the left hand side of the window or use the ‘next' and ‘previous' options to move through the pages. Don't use your browser's 'back' button.

Click on the numbered sections on the left hand side of the window or use the ‘next' and ‘previous' options to move through the pages. Don't use your browser's 'back' button.

 and  image. and Click on the numbered sections on the left hand side of the window or use the ‘next' and ‘previous' options to move through the pages. Don't use your browser's 'back' button.

 and  image.