Get help for an adult

If you or someone you know needs social care, tell us about it using our online form.

We have limited resources and so we use government guidelines in allocating care according to need. You can find out more about how we do this on the Access to Care page.

iCM Form

Please read all questions carefully and remember to complete all fields marked '*'
You can also be assessed over the telephone by calling 0845 130 4959.
Are you completing this form for yourself?
1. Yes
2. No, someone else
If it's for someone else, please give details below:
1. What is your relationship to them?
2. Do they know you're contacting us?
About your needs
1. General health *
2. Toileting *
3. Dressing *
4. Bathing *
5. Mental health *
6. Mobility *
7. Getting out and about *
8. Cooking and preparing food *
9. Cleaning *
Additional information
1. Please use the box below to tell us about any medical issues:
Name of person in need of assessment
1. First name*
2. Surname*
3. Address*
4. Postcode*
5. Telephone*
6. Email
7. Gender *
8. Age range *
9. Living arrangement *
Name of person completing the form (if different)
1. First name
2. Surname
3. Address
4. Postcode
5. Email
6. Telephone

Contact us

Adult Social Care
Town Hall & Civic Offices,
Westoe Road
South Shields
Tyne & Wear
NE33 2RL
0845 130 4959
adultsocialcare@
southtyneside.gov.uk

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