Carer Registration - Wansford Surgery & Kings Cliffe Practice

Register a Carer

Do you care for someone who could not manage without you?

You may be a carer if you provide help and support to a partner, relative, child, friend or neighbour who could not manage without your help due to physical or mental illness, disability, frailty or addiction.

Looking after the Carers health

As a carer, it is important that you look after your own health; it is easy not to look after your own health when you are looking after someone else.

We want to help carers stay as fit and healthy as possible. We can only do this if you let us know you are a carer.

We keep a register of carers who are our patients so that we can let you know about any new services or support that becomes available.

About You

First Names

Surname

Date of Birth

Email Address

Enter Email Confirm Email

Contact Number

Carer Information

What is your relationship to the person you care for?

Please specify your relationship with the person you care for

Is the person you care for registered at this surgery?

Yes

What is the name of their GP surgery?

Cared for Person's Details

Cared for Person's First Name

Cared for Person's Surname

Cared for Person's Date of Birth

I consent to the practice collecting and storing my data from this form.

I give my permission for my name to be added to the practice Carer Register. I am aware that the practice will be unable to share information relating to the cared for persons medical records unless the cared for person completes and signs a separate Consent Form. Please ask at Reception for details. This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. The internet is not a secure place, however, we have gone to great steps in making sure the information you submit to us is as secure as possible. We use SSL (Secure Socket Layer) certificates to encrypt the communication between your computer and our web server. If you are not completely happy to provide information via the internet please contact the practice directly.

Name Optional

This field is for validation purposes and should be left unchanged.