Carer Identification

Page {{ paginatorProps.current }} of {{ paginatorProps.total }} ({{ paginatorProps.percentage }}% completed)

You are a carer if you look after a family member or neighbour who could not manage normal day to day living without your help.

By identifying yourself as a carer, we will be able to support you and signpost you to the support services available to you as a carer.
If you consent, we will also refer you to Adult Social Care for an assessment; they will identify your needs and provide further support to you as a carer.

For the purposes of this form, you are not a carer if you are employed to do so or you are volunteering to do so through a helping organisation. This would make you a care worker.

Your details as the carer

If required

Please double check you've entered the correct email address

Processing

Details of the person you look after

Does this person live at the same address as you?: *

Does this person have different Contact Telephone Numbers to you?: *

If required

Is this person living with Dementia?: *

Are they registered at this surgery?: *

Processing

Additional Questions

Would you like a call from our Carers Lead?: *

Would you like to receive carers’ updates via email?: *

Would you like assistance to register with Carer Support services?: *

A Carer Assessment under the Care Act will give you an opportunity to discuss with a Carers Case Worker (Council) your caring role and what support you may need. Would you like us to initiate a referral for you? : *

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

Processing

There appears to be a problem loading the form, please refresh the page.
If the error persists please contact us.

Carer Identification

You are a carer if you look after a family member or neighbour who could not manage normal day to day living without your help.

Privacy Consent

THE BARN SURGERY

PEACEMARSH SURGERY

PRACTICE POLICIES

Functional Cookies

3rd Party Cookies