Carer Registration

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Carer Registration

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

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All questions marked with a * are mandatory

Your Details
Please double check you've entered the correct email address
May be used to identify you
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Details Of Person Being Care For
Is the person you care for a patient at this surgery?:
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Carers Consent
If not already, I give my consent to be added to the Carers Register at the Surgery: *
Carers who provide regular and substantial care are legally entitled to a Carer Assessment. I would like to be referred for a Carer Assessment of Needs: *
I would like to receive regular carer's updates/newsletters : *
I have difficulty understanding written information and need help: *
I would like to receive carers information via SMS text message: *
I would like to receive carers information via email: *

Privacy Consent

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