Register as a carer

If you are looking to become a carer or to support a relative or friend, you will need to register as a carer. This is so we can let their GP know that you can access their information. We also need to let the Government know about the number of carers registered at the surgery. Complete the form below to register as a carer.

Name Required

Prefix First Last

Email Required

confirm your Email Required

Address Required

Street Address Address Line 2 County / State / Region Postcode

Date of birth Required

Please enter the name of the person you are caring for Required

Prefix First Last

Please enter the address of the person you are caring for Required

Street Address Address Line 2 County / State / Region Postcode

Please enter THEIR date of birth Required

Is the person you are caring for a patient at this surgery? Required

Yes

Please tick the box to confirm that you understand this form is NOT for urgent medical help Required

I understand this form is NOT for urgent medical help

By submitting your details you are consenting to providing this information for improving our services to you. The date you supply on this form will be securely stored on our website, which is hosted by a third party. We will retain this information on the website for no longer than 30 calendar days. Your contact details will not be sold or shared with a third party. I understand that i can revoke this consent at anytime by contacting the practice. Our privacy policy can be viewed on this website. Required

I agree to the privacy policy