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Request a care assessment

Who can get help?

We use National Eligibility Criteria to help determine what kind of support you need as well as what help you are eligible for.

For details about eligibility and more about the care assessment process, see:

About care assessments

Emergencies

If it's an emergency, please phone us immediately on:

0191 424 6000

Mon to Thurs 8.30am to 5pm, Fri 8.30am to 4.30pm.

0191 456 2093

Evenings, weekends and bank holidays.

  1. Referrer details
    1. Are you completing this form for yourself? *
    2. Your relationship
      1. Do they know they are being referred?
  2. Your details
    1. Label
  3. Your address
  4. About your needs
    1. In order to help you we will need some basic information about how you are able to handle day-to-day life. Please provide any additional information, such as medical conditions or things you feel that we need to know, in the box below.

      In order to help the person you are referring we will need some basic information about how they are able to handle day-to-day life. Please provide any additional information, such as medical conditions or things you feel that we need to know, in the box below.

    2. Confidentiality

      To provide the best services we may need to discuss your circumstances with other professionals. You would be asked before this happens. We are happy to discuss any worries you may have.

  5. Your details
    1. Label
  6. Your address

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