Hide this message
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 we 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 you have concerns or want to report abuse phone Hampshire Adults' Health and Care on 0300 555 1386 or the police on 101.
In an emergency, or if you suspect you or someone else is in immediate danger, phone 999.
By ticking this box you are confirming that Hampshire County Council Adults’ Health and Care Department will collect and use the information that you provide on this form in order to progress your request for support. We do not share the information on this form with any third party without your consent unless required by law or to protect vital interests. Our normal practice is to keep this information for seven years. But, some information relating to looked after children can be kept for up to 100 years. The information you are providing today will not be used for automated decision making. For more information, please refer to our privacy statement.
NewsletterStay connected - subscribe to our newslettersgo
The Castle, Winchester SO23 8UJ