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Support for adults

Assessing yourself form

This is a downloadable form in Microsoft Word format.

There are 3 sections of this form to complete:

  • Your essential information.
  • Giving your consent.
  • Your situation.

All questions marked [*] must be answered before you return the form.

It is about what you think your needs are, in your own words, but you might find it helpful to have someone to help you and you may wish to ask your carer or a family member or friend to assist.

Please call us on 0345 155 1007 (Monday – Friday 8am – 8pm, Saturdays 9am – 1pm) if you feel you need help to fill in this form.
Download form

Before you start

Assessing yourself is suitable for you if you:

  • think you have social care needs
  • are aged 18 and above
  • live in Devon AND
  • feel that you can fully understand and discuss your own needs and how they can be met (this is called assessing our mental capacity)

This is not a form for carers – but if you care for another adult, find out about an assessment for yourself by phoning Devon Carers on 03456 434 435 or visiting their website for information and advice:

If you’re not sure which council area you live in use the Find my council tool to find out.

Sending your form

Details of how to send us this form and what to expect are included in your download.

What will happen next

When we have received your form, we will review it and contact you to discuss your situation and how we can work together. We will normally contact you by telephone unless you have asked us to get in touch in some other way.

We aim to contact you and work with you within 28 days of receiving your form.

If we do provide a service to meet your eligible needs, we will talk to you about having a financial assessment. You may need to make a contribution towards the cost of your care and support.

National eligibility criteria

We apply national Care Act (2014) eligibility criteria to decide if we can provide you with social care support.

We will meet your social care needs if an assessment shows that:

  • your needs arise from or are related to, a physical or mental impairment or illness and
  • as a result of your needs, you are unable to achieve two or more specified outcomes in the Care and Support (Eligibility Criteria) Regulations 2014


  • as a consequence, there is or is likely to be, a significant impact on your wellbeing

For more information about policies with regards to being financially assessed and the eligibility criteria, please take a look here