Self-referral for 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:

• send an email to accesspoint@brighton-hove.gov.uk
• phone 01273 29 55 55

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