Contact Adults' Health and Care

Before completing this form, we recommend that you visit Connect to Support Hampshire to explore what help and support is available in your area. Many of the community based services listed in the Community Directory are free or low cost and available to everyone.

The services that Hampshire County Council offer may require a financial contribution and the amount that may need to be contributed will be subject to a financial assessment. If the individual has more than £23,250 savings then they are likely to have to pay the full cost.

If your request is urgent, for example you need support in the next 24 hours, contact Adults' Health and Care on 0300 555 1386.

Initial Questions
Are you making contact with us ... required
Is this request for yourself, or are you submitting this on behalf of someone else? required
Has the individual consented to you making this request? required
Does the individual have the mental capacity to make this decision? required
Is the individual ... required
Your details
Manually enter your address if you live outside Hampshire, or cannot find your address
Manually enter your address if your address is outside of Hampshire, or you cannot find your address
For example: 31 12 1980
The AS reference can be found any correspondence from Adults' Health and Care
The NHS number will be on any letter or document received from the NHS, such as prescriptions, test results and appointment letters
Manually enter the address if the address is outside Hampshire, or you cannot find the address
Individual's details
Manually enter the address if the address is outside Hampshire, or you cannot find the address
For example: 31 12 1980
The AS reference can be found on correspondence from Adults' Health and Care
The NHS number will be on any letter or document received from the NHS, such as prescriptions, test results and appointment letters
Manually enter the address if the address is outside Hampshire, or you cannot find the address
Questions about support request
For example: washing/showering, getting dressed, using the home safely
For example: recent illness, health has declined
For example: strip washing, using a neighbour's shower
For example: spouse, family, paid support, health professionals, housing professionals, voluntary sector, carer/care provider
For example: equipment, spoken technology, interpreter
Please select the days and times which are best to contact the individual concerned required
Questions about support request
For example: advice on equipment or adaptions to increase ability to perform day-to-day tasks around the home, or mobility outside, or care technology or personal alarms
Please select the days and times which are best to contact the individual concerned required
Questions about support request
Please select the days and times which are best to contact the individual concerned required
Questions about support request
Please select the days and times which are best to contact the individual concerned required
Hampshire County Council Professionals will make a decision on the next steps following submission of this form
Questions about support request
For example: equipment, spoken technology, interpreter
Please select the days and times which are best to contact you required
Questions about support request
For example: equipment, spoken technology, interpreter
Please select the days and times which are best to contact you required
Questions about support request
For example: washing/showering, getting dressed, using the home safely
For example: recent illness, health has declined
For example: strip washing, using a neighbour's shower
For example: spouse, family, paid support, health professionals, housing professionals, voluntary sector, carer/care provider
For example: equipment, spoken technology, interpreter
Please select the days and times which are best to contact them required
Questions about support request
For example: advice on equipment or adaptions to increase ability to perform day-to-day tasks around the home, or mobility outside, or care technology or personal alarms
Please select the days and times which are best to contact the individual concerned required
Questions about support request
For example: equipment, spoken technology, interpreter
Please select the days and times which are best to contact you required
Questions about support request
For example: equipment, spoken technology, interpreter
Please select the days and times which are best to contact you required
Questions about support request
Questions about support request
Include details of any children or young people involved in the care and if there is more than one person being cared for
For example being able to work/fulfil other family commitments, improving own health and wellbeing, planning for emergencies
For example family, paid support, health professionals, housing professionals, voluntary sector, care provider
Questions about support request
For example prevent the person leaving the setting, control or supervise to manage behaviours to meet needs.
For example to prevent injury, to prevent wandering, to manage needs, to prevent harm to others
Questions about support request
For example, do they have dementia/Alzheimer's
Please select the days and times which are best to contact the individual concerned required
Hampshire County Council Professionals will make a decision on the next steps following submission of this form
optional
 

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