Register as a Carer

Do you care, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without your support?

If so, you are a Carer and we would like to support you. Please complete this form.

If you would like to be referred to the Carers Centre, which is a countywide organisation providing relevant information and advice, you can also specify this in the form below.

  • Carer Details

    Date of Birth
    For example, 15 3 1984

  • Details of Person Being Cared For

    Date of Birth
    For example, 15 3 1984
    Is the person you care for registered at this surgery
    With your permission we can make a note of you being a Carer on your medical records. Agree to this by selecting the tick box below. We can also refer you to your local Carers service for information, advice and support, tick the below box to agree to this. If you or the person you care for is urgently in need of support, please ask us to refer you to social services or call them directly without delay. (optional)
    This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.
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Page last reviewed: 04 September 2025
Page created: 02 October 2026