Carers Form

If you believe that you may qualify as a carer then we please ask for you to complete the form below and either email this back to us or drop this off at the surgery.

A clinician will review the form to confirm whether you are classed as a carer or not. Filling out the form does not automatically mean that you will be officially labelled as a carer.

We ask that you fill out the form with as much detail as possible such as hours you care for that person, what care you provide for that person, are you the sole carer etc.

The more information we have the better we can assess the situation and decide on an outcome.

With regards to the covid vaccine we have had an influx of patients stating they are carers who haven’t informed us of this before and we therefore need information to assess this as to whether they do indeed qualify to be a carer and therefore get the vaccine or whether they do not class as carers. We would like to remind you that all patients over the age of 50 will be invited for a vaccine and so if you fall into this category we ask that you are patient and await to be contacted.

If you wish to email the form back to us then please send it to: [email protected]