Register as a Carer

If you’re a Carer who helps and supports someone who can’t manage on their own, we want to ensure YOU get all the support YOU need. To be able to do this, we need to know certain facts about your caring situation. Please register as a carer.

 

Register a Young Carer (aged 5 to 25)

Young carers are children and young people aged between 5 and 25 years whose lives are affected by caring for a family member or friend

You can view more information and make a referral from these links:

Support for carer
Support for a young carer
Register as a Carer

  • Carer Details
  • Patient Details
  • Submit

Carer Details

Full Name

Date of Birth

Address & Postcode

Home Phone

Mobile Phone

Any Relevant Information

Details of the person you care for

Full Name

DOB

Address & Postcode

Home Phone (if different)

Mobile Phone (if different)

Any Relevant Information

Consent

I declare that the information provided on this form is correct to the best of my knowledge

I consent to being contacted via the details given above. I agree to the privacy policy

To view our privacy policy, click here