Register carer details

DORDON & POLESWORTH GROUP PRACTICE

CARERS FORM

Do you look after someone who is ill, frail, disabled or mentally ill? If so, you are a carer.  The Practice is interested in identifying carers, especially those people who may be caring without help or support.  We know that carers are often “hidden” looking after a family member or helping a friend or neighbour with day to day tasks and may not see themselves as a carer.

We feel that caring for someone is an important and valuable role in the community, which is often a 24-hour job that can be very demanding and isolating for the carer.  We further believe carers should receive appropriate support by way of access to accurate information on a range of topics such as entitlement to benefits and respite care and not least, a listening ear when things get too much.

As a Carer, you are also entitled to have your needs assessed by Social Services. The Assessment is a chance to talk about your needs as a carer and the possible ways help could be given. It also looks at the needs of the person you care for.

Please complete this form and if you are agreeable, we will pass your details to Social Services to have your needs assessed.

 

1Your details

2Details of the person you look after


Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


© Dordon and Polesworth Group Practice 2018
Dordon Surgery - 162 Long Street, Dordon, Tamworth, Staffordshire, B78 1QA
Polesworth Surgery - High Street, Polesworth , Tamworth, Staffordshire, B78 1DU
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