Carers

At Harwood Group Practice, we are committed to recognising and supporting patients who provide ongoing unpaid care to others.

This form is used to register, review and maintain accurate information within our Carers Register. A carer is generally someone who provides regular unpaid support to a family member, partner, friend or neighbour who could not manage without assistance due to illness, disability, frailty, mental health needs or other long-term conditions.

Maintaining an accurate Carers Register helps the practice identify patients with genuine caring responsibilities and ensures appropriate support, communication and services can be offered where applicable.

Please complete this form if:

you wish to register as a carer
your caring responsibilities have changed
we have contacted you to confirm or review your carer status

Please note:

Caring responsibilities should be regular and ongoing
The caring role must be unpaid (excluding benefits such as Carer’s Allowance)
If your caring responsibilities end or change, you must inform the practice so your records can be updated
We may periodically contact you to review and reconfirm your caring responsibilities
If an updated form is not completed within 28 days of contact, your carer status may be removed from our Carers Register until confirmation is received

All information provided within this form will be added to your medical record and processed in accordance with UK GDPR, NHS confidentiality requirements and practice policies.

Thank you for helping us maintain accurate records and ensure support is directed appropriately.

Carer Details

Name *

Date of Birth *

Phone Number *

Email Address *

Address *

Postcode *

Details of Person Being Cared For

Full Name of the person you care for *

Date of Birth *

Address *

Postcode *

What is your relationship to the person being cared for? *

Which GP Surgery are they registered at? * (Please type 'Harwood Group Practice' or the name and town of their current surgery) *

Consent and Future Reviews

Do you have a "Carer’s Emergency Plan" in place? *

Yes No

Do you consent to being contacted annually for a Carer’s Health & Wellbeing Review? *

Yes No

Do you give consent for us to record your name as a Carer on the medical record of the person you care for (if they are a patient here)? *

Yes No

Agreement: I confirm that the information above is correct and I agree to notify the surgery if my caring role ceases. *

I Agree

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. *

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

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Page last reviewed: 11 May 2026
Page created: 18 November 2025

Carers

Carers

Further Information