Register a Carer

Do you look after someone who is ill, frail, disabled or mentally ill? If so, you are a carer.

It is important that we know if you are a carer so that we can make sure you receive information, services and the help that is available. If you are a carer please complete this form.

Application to Discuss the Records of the Person you Care For

  • Does the person you care for require help when ordering medication or booking an appointment?
  • Would they want assistance with dealing with their health and any medical recorded information?
  • If so have you considered obtaining third party consent in order to discuss the records of the person you care for? Just ask at reception for a Third Party Consent Form which the person you care for will need to read and complete before it is handed back to reception.
Register a Carer

Register a Carer

Carer Details

Please use this date format: DD/MM/YYYY.
Any responses we send will go to this email address.

Details of Person Being Cared For

Please use this date format: DD/MM/YYYY.
Is the address of the person being cared for different than the above? *
Are you the next of kin? *
Are you the emergency contact? *
Are you the main carer? *
Is the person you care for a patient at this surgery? *
Have you applied to the council for a carers assessment? *