[Your name]
[Your address]
[Date]

Adult Social Care
[Council name and address]

Dear Sir or Madam,

Request for a care needs assessment

I am writing to ask for a needs assessment for [me / name, date of birth, address], under section 9 of the Care Act 2014.

[I / They] need help with:
- [for example: washing and dressing]
- [for example: cooking and eating]
- [for example: moving around safely]

Please contact me on [phone number] or [email] to arrange this. Please tell me how long it will take, and send the outcome in writing.

[If writing for someone else: They know about and agree to this request.]

Yours faithfully,
[Your name]

Free template from Social Care Made Easy. Information only, not legal advice.