This form is for requesting Adult Social Care help, such as:
- Regaining skills and confidence after an illness.
- Providing support for a disability.
- Improved independence or safety through equipment or adaptations (for example perching stools, raised seats, bath steps or riser recliner chairs).
- Find out more about care homes or having care in the home.
- Carer support.
Adult Social Care provides a range of information, advice and services for adults with care and support needs or who have caring responsibilities.
We help people to live as independently as they can in their own home, where possible. Before completing this form you might find the answers you are looking for by visiting our website: My life my care
Please be aware, this form is only to be used by people who are either living in Bournemouth/Christchurch or Poole areas, or are referring someone who lives in those areas. A postcode will be requested later in the form to confirm this.
If you require urgent out of hours support, please follow this link for further information: Adult Social Care Emergencies
All fields with a red * are mandatory fields that require completion before the form will allow you to move on.