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
Contact the emergency services on 999 if you feel that you or an adult you're referring requires medical attention urgently.
If you want to refer yourself or other adult person to occupational therapy, use an Occupational Therapy referral
You can access an occupational therapy assessment to help identify what practical measures, equipment or adaptations and advice you can get to ensure your safe and empowered independence.
You may find the information you need online:
For information about walking aids, such as wheelchairs, walking sticks, mobility scooters, you need to consult your doctor.
If you're a professional and want to contact us about safeguarding, use a safeguarding online form
If you would still like to fill in our online form click the "Next" button. You must answer all questions unless marked as optional.
You can fill in this form for yourself or someone else can do it on your behalf.
Tell us about a problem with a form, page or Citizen Portal account