Carer Support

Do you provide support to a partner, relative, friend or neighbour who couldn’t cope without your help? This could be due to old age, frailty, disability, a serious health condition, mental ill health or substance misuse. If the answer is yes, you are an Carer.

Many carers do not identify themselves as a carer. Instead, they see themselves as someone’s partner, relative or friend who is simply ‘doing their best’ to help someone.

There are many benefits of being identified as a carer, which include:

Free hospital parking*
Free Flu jabs
1:1 support
Free Health and Wellbeing checks
Carers support groups or activities
Free Emergency Card + back-up plan.

*Conditions apply

If you would like to register as a carer, please collect a registration form from reception, or complete the form below.

Carer Identification Form

Please complete and submit the below carer identification form

Step 1 of 3

Phone Optional

This field is for validation purposes and should be left unchanged.

Do you look after someone – a relative, friend or neighbour who is ill, frail or disabled and is unable to or has difficulty looking after themselves? Do you give support to someone who has mental health needs or misuses alcohol or drugs?

If you are, that means you are a carer and by registering that you are a carer with the Practice it could mean that we are able to offer you more support.

Carers Details

Full Name Required

Date of Birth Required

Contact Phone Number Optional

Email Optional

Address Required

1St Line of address Town Postcode

Relationship to person cared for Required

I live with the person I care for Required

I am their next of kin Required

I am their emergency contact Required

I am the main carer Required

If I have a health problem I may need the practice to see me during limited times or to provide a home visit Required

I give permission for my details to be passed to the local Carers support centre for advice and support Required

I give consent to being registered as a carer with this practice Required

Details of Person Cared For

Full Name Required

Date of Birth Required

Contact Phone Number Required

Email Optional

Address Required

1St Line of address Town Postcode

I give consent for the above information about me to be recorded on the clinical record of the person who cares for me. Required

I give consent for the details of my carer to be held on my medical records Required

I give consent for relevant medical information to be shared with my carer Required

Your Declaration

I confirm that: Optional

The information I have given in this form is correct

I am the parent or legal guardian of the dependent person I am making a choice for set out above (if applicable)

If you have ticked the box asking to be referred to the Carer Support worker, Aleigha will contact you to offer support, or arrange a Carers Health and Wellbeing Assessment.

Ask us about a free Carer’s Passport: