This form has a maximum of 17 pages
It is appropriate to refer yourself to adult social care when:
- You are struggling with daily living tasks and you have not been able to make improvements by accessing community support or equipment available on the high street.
- You want to make changes to your life, and you are not able to do so by yourself or with the help of a carer / family / friends.
- Under the Care Act 2014, there is eligibility criteria for some services. Questions will be asked about what you can and cannot do to determine your eligibility.
In addition to a referral to adult social care you can find information and advice by:
- Visiting Care Place to find out about community support available in Ealing at www.careplace.org.uk.
- Purchasing recommended equipment on the high-street, from pharmacies and local specialist shops.
Please note: The care and support the council arranges and/or provides is not free. We will complete a financial assessment with you to work out how much you can afford to pay. The council may contribute towards the cost.
If the matter is urgent or you are raising a safeguarding alert, please call social services on 020 8825 8000 (adults’ option) to discuss the referral.
If there is a medical emergency, immediate danger to life, risk of injury or if a crime is being committed, dial 999.
You will need
- next of kin details
- GP surgery name, address and telephone number
- explain your situation or recent changes
- information on any difficulty with daily activities and mobility
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