By answering some quick questions about your current situation we can direct you towards information, advice and services that could help you to live independently and improve your wellbeing.
To check other community based options prior to completing this form visit Live Well Cheshire West for information and advice available in and around your area.
This form advises how likely you are to be eligible for care and support, and indicates if you may have to pay for some or all of any support you may receive.
You can complete it yourself or on behalf of someone else. It usually takes around 10-15 minutes to complete. You will be able to attach any supporting evidence within this form if you wish too.
Please note that this form should be submitted on behalf of adults (over 18) only
Once submitted, this form will go to the Cheshire West and Chester Community Access Team. You will receive a confirmation email message once the form is submitted and follow up calls if required. The team aim to respond within 3 working days. Please complete this form to the best of your ability and with as much information as possible.