Your browser does not appear to support JavaScript. You may want to try one of the following:
Sorry, something's gone wrong with this form.
This may have happened because the form was open for a long time.
We haven't saved any personal information you entered. We do this for your security.
Try loading the form again:
If this doesn't work, please use the website feedback form to tell us there's a problem.
Show details
Hide details
Use this form to tell us about a problem with the Contribution Calculator.
If you need more information about the calculator go to the How to calculate your contribution towards your care costs page.
Your contact details
Provide your contact details so that we can respond to your issue if required.
Tell us about a problem with a form, page or Citizen Portal account