Subject: Request for Care Act needs assessment

I am asking the council to assess my needs for care and support.

My disability/health condition affects:
• [personal care]
• [nutrition/home tasks]
• [relationships/community access]
• [work/education]
• [safety or managing daily life]

The impact on wellbeing is: [detail].

Please confirm receipt, the assessment process, any information you need from me and the next steps after assessment.