Carer Information

It’s important that everyone who works here at Harbury Surgery knows you are a carer so that we can offer you help and support if you need it. Anyone who looks after a friend or family member who cannot manage without them, and is unpaid, can register. This includes carers under the age of 18.

If you are a carer, please complete this form below.

Tell us about yourself

First Name *

Last Name *

Home address *

Postcode *

Date of Birth *

Phone Number *

Email Address *

Relationship to the person you care for *

Do you have a Lasting Power of Attorney? *

Please state which type of Lasting Power of Attorney is in place *

Are you happy for us to send your details to the local carers support service? *

Have you or the person you care for ever served in the Armed Forces? *

Details of Person being cared for

First Name *

Last Name *

Date of Birth *

Home address *

Phone Number *

Age of the person you care for?

Nature of the condition/disability of the person being cared for

Is this person registered at the Harbury Surgery? *

Are you in receipt of carer’s allowance? *

Are there any other carers in the household?

What additional support do you feel you need?

Further details on Carer Support can be found here.

I give my consent to the practice to contact me

Please specify

By Email

By Phone

I want a copy of the contents of this form to be emailed to me

I confirm that I am a registered patient at Harbury Surgery*

By submitting this form, you are giving consent for the Harbury Surgery to keep a record of your contact details on the cared for person’s medical records.

Please be aware that should any of the above details change, it is your responsibility to notify the Harbury Surgery of the changes.

Fields marked with an asterisk (*) are mandatory

FAQs

Am I eligible as a carer?

A carer looks after a family member, friend, partner or neighbour who needs support due to illness, disability or old age. The help carers give is unpaid, though you may still receive Carer’s Allowance or other benefits. You do not have to care full time to receive Carer’s Allowance or live with the person you care for to be a carer.

I don’t live in the same borough/county as the person I care for – where do I go for help?

It is the duty of the local authority (council) where the person you care for lives to assess their care and support needs and your needs as a carer. For example, if the person you care for lives in Sutton, the London Borough of Sutton would be responsible for assessing their support needs and offering you a Carer’s Assessment.

What is Carer's Allowance and how do I claim it?

Please click here for the latest carer’s allowance information.

Where could I receive more details on Carer Support?

There is a wealth of information on the NHS website about carers and caring. Below are some links into the site that we hope you will find useful.

Finance and Law

Help claiming benefits, looking after your bank balance and understanding the legal issues of caring.

What is Warwickshire Carer Wellbeing Service?

What is Care Companion Tool?

Carer Information

Tell us about yourself

Details of Person being cared for

Finance and Law

Patient Info

Policies

About Us

Locations

GET THE NHS App

CQC Rating

GET THE NHS App