Self-referral for Adult Social Care

Apply for help for yourself from Adult Social Care.

Use this form to:

  • refer yourself for help from Adult Social Care

To apply you'll need your:

  • personal contact details
  • GP's contact details

If you're not sure if you fall under Brighton & Hove City Council, you can check your local authority.

If you need help filling in this form, you can:

We process, analyse and use your data in a range of ways to better understand what our customers need and to improve the way in which the council delivers your services.

Find more information about how we use your data in our privacy and data notice.