[Your name]
[Your address]
[Date]

Adult Social Care
[Council name and address]

Dear Sir or Madam,

Request for a carer's assessment

I care for [name], who is my [relationship]. I am asking for a carer's assessment under section 10 of the Care Act 2014.

Caring affects my [health / sleep / work / time for myself]. I would like to talk about support for me, such as breaks.

Please contact me on [phone number] or [email]. Please send the outcome in writing.

Yours faithfully,
[Your name]

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