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Referral for an adult needs assessment

Please note, if you need a Wheel chair assessment, you will need to contact the Health and Wellbeing team.

Apply For Help With Your Care And Support Needs
1. Are you making the referral on behalf of yourself or someone else?*
  
  Someone Else
  
  Self
2. Professionals
  1. What is your relationship to the person requiring care
    
    Family
    
    Neighbour/Friend
    
    Housing Provider
    
    Healthcare Professional
    
    Professional
  2. Which organisation do you work for?
3. Before you proceed, any information you supply today and in the future about you or whoever you’re contacting us about will be stored in our computer system – it’s a secure system and only authorised staff have access to it. This is so we’ve got a note of your contact and we can work out the best way to help.
  Depending on what help you need, we may need to share some of your information with other organisations – for example the NHS if they’re better placed to help you – but we’ll only do this where it’s necessary and any sharing will be as secure as our records are.
4. Do you want to complete the assessment?*
  
  Yes
  
  No
5. You must agree to the assessment being completed, by changing your answer to “yes”. If you do not want to proceed but still require some help the Community Hub provides details of advice and support and can be accessed via the Sunderland Service Directory