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. If you are a carer please complete this form.

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Section

Address:

Details of Person Being Cared For

Full Name: *

Date of Birth: *

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

Address including postcode:

What relation to you is the person being cared for?

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

Yes

In relation to COVID-19

I am either in receipt or eligible to carer’s allowance or I am the sole/ primary carer of an elderly or disabled person who is at increased risk of COVID-19 mortality and therefore clinically vulnerable.

Those clinically vulnerable to COVID include children with severe neuro-disabilities, those who are designated Clinically Extremely vulnerable (CEV), adults who have underlying health conditions (as defined in table 3 of the Green Book) and those who need care because of advanced age.

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Register a Carer

Register a Carer

Section

Details of Person Being Cared For

Self Help