Carers Registration Form

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By completing this form you will be added to the GP Surgeries Carers Register so that we can support you as a carer

Carer Information
Title: *
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Carers Support

Caring can be a lifelong commitment for some, while for others it can be a sudden responsibility.

Carers Support West Sussex are dedicated to offering unpaid Carers information, guidance, and emotional support. Their aim is to deliver a well networked and supportive approach for each carer in the city/town or village in which they live. It is about having a richer and deeper presence within each district of West Sussex, providing local solutions to family and friend carers.

More information about Carers Support

Would you also like to be registered with Carers Support?: *

Carers support will be in touch with you directly once they are aware you wish to be registered

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Cared for Person Consent (optional)

I consent for information about my health and wellbeing to be discussed with the person named on this form as my carer. I consent for my named carer being recorded on my medical records and that this person may request and/or collect my repeat prescription, test results and have access to online appointments and prescriptions.

I will contact the surgery if this information changes.

Title:

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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