Are you a Carer Registration Form

If you are looking to register that you have a carer please complete the Do you have a Carer form

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Carer Registration

Are you a carer?

Do you look after someone who is ill, frail, disabled or mentally ill?

If so you may be a carer. Please read the information below. If it applies to you complete this form and return to our Care Navigators.

Definition of a Carer:

Individuals irrespective of age who provide or supervise a substantial amount of care on a regular basis of a child, relative, partner or neighbour who is unable to manage on their own due to illness, disability, frailty, mental illness or impairment.

You could be a volunteer from a voluntary agency, a paid carer or member of the family.

If you are a carer please complete this form


All questions marked with a * are mandatory

Your Details
Please double check you've entered the correct email address

Help Us To Help You 

Providing a NHS Number means that we can find a patient record more accurately, saving time and resources. 

How to find your NHS Number 

e.g. cooking, driving, shopping, personal care
May be used to identify you
Details Of Person Being Cared For
Is the person you care for a patient at this surgery?:

Privacy Consent


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