Register 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.

• Do you look after someone who is sick, disabled or elderly/frail?
• Would they struggle to live in their home without your help?
• Are they a parent, child, partner, relative, friend or neighbour?
• Are you – or is someone you know providing much-needed care for a loved one?
• Are you unpaid and acting voluntarily?
• Are you juggling work alongside your caring role?

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

Find out more about Carers support

Register a Carer - Kintbury & Woolton

Register a Carer - Kintbury & Woolton

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Section

Address:

Relationship to the person you care for

Is the person you care for a patient at this surgery?

Yes

No

Any other relevant information

I consent to this information being shared with the Carers Partnership Berks/The Princess Royal Trust Hants

Yes

No

To find out more, please visit the following websites:

• Carers Partnership - Reading and West Berkshire
• Support for Carers - West Berkshire Council
• Carer Support & Dementia Advice for Hampshire - Mind Andover
• The Princess Royal Trust - Fore Carers in Hampshire

Details of Person Being Cared For

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Address including postcode:

Any other relevant information

*

I confirm that I am currently within the UK at the time of sending my enquiry.