Information about my situation

Pre-Assessment Questionnaire

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Adult with Support Needs

Are you already in receipt of services?

Before you get started

What will I need to complete this form?
 
You will be required to create a portal account, or log in to an existing account, in order to complete and submit the form.
 
 Please provide as many details as possible about the situation you feel we could support with. Please describe:
 
  • What help is required
  • What you or the person you are referring are finding difficult
  • What is currently working well
  • What outcomes you or the person you are referring are looking to achieve
If you are known to us, this form is not designed to meet your needs. Instead, we recommend completing Request for Access to my account form. This will be processed by the Adult Social Care team. image. If you are known to us, this form is not designed to meet your needs. Instead, we recommend completing Request for Access to my account form. This will be processed by the Adult Social Care team.

How does this tool work?

You can complete this form for yourself or on behalf of someone else i.e. if you are a Carer, Relative or Friend.

How to Navigate

Click on the numbered sections on the left hand side of the window

or

use the Click on the numbered sections on the left hand side of the window or use the and options to move through the pages. Don't use the Browser 'Back' button image. and Click on the numbered sections on the left hand side of the window or use the and options to move through the pages. Don't use the Browser 'Back' button image. options to move through the pages.

Don't use the Browser 'Back' button

Progress

When progressing through the form, the progress bar

When progressing through the form, the progress bar will show you how far through completing the form you are. image.

will show you how far through completing the form you are.

The Form

Questions You DO NOT need to answer every question, you need only complete what is relevant. The form uses many different types of questions, including lists and text fields image. Questions


You DO NOT need to answer every question, you need only complete what is relevant.

The form uses many different types of questions, including lists and text fields
Select the option(s) that best describe your situation. image. Select the option(s) that best describe your situation. image. Select the option(s) that best describe your situation.
This symbol This symbol indicates that the question is mandatory and must be answered in order to continue. image. indicates that the question is mandatory and must be answered in order to continue.

Options

Save the Form

Use the Save the Form Use the option to Save the form to return to at any time. image. option to Save the form to return to at any time.

Print the Form

Use the Print the Form Use the option to Print a copy of the form if required. image. option to Print a copy of the form if required.

Having Difficulty Understanding the Assessment Process?

If someone speaks on your behalf, they are commonly known as an advocate.

 An advocate will represent your best interests and, if you are vulnerable, will ensure you are safeguarded from harm. The role of an advocate is to ensure people who may not be able to represent their views clearly can be supported make their own decisions about the care and support they receive. This may be people with learning disabilities or mental ill health issues, or even older people.

Advocates remain independent from social care providers, will not try to influence the decision-maker or put forward their own views. The council does not provide an advocacy service, but some local organisations do and they can assist you in finding an advocate.
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