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

Register a Carer

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Carer Details

Full Name: *

Date of Birth: *

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

Email Address: *

Responses we send will go to this email address

Phone Number:

Address including postcode:

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 Hub

Yes

No

Website: www.berkshirecarershub.org

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

FOR STAFF USE

Please enter read code IS A CARER: #918G

Please enter read code CARED FOR: #918F

*

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