Register a Carer

Many people have caring responsibilities every day which involves giving unpaid support to a family member or friend who may need physical help or have a disability, long-term condition, or mental health, alcohol or substance misuse issues. It is important that we identify carers in order that their responsibilities do not have an impact on their own health or that of the person they are looking after.

The Practice works closely with Carers in Hertfordshire who provide excellent support and can be contacted directly on 01992 586969 or via www.carersinherts.org.uk.

If you are someone who is supporting someone else (unpaid), or someone who relies on another person for help and support, please complete the details below. 

Last Updated: 20/03/2024

  • For the person filling in the form

    COULD YOU BE A CARER? Are you looking after someone unpaid who has a disability, long-term condition, mental health problem, or alcohol or substance misuse issues? 

    DO YOU POSSIBLY RELY ON A CARER? Do you rely on someone, whatever age, who is unpaid without whom you would not be able to live independently or your health and wellbeing would deteriorate without their help? 

    Follow the instructions to let us know and help us keep our records up to date.

  • My Details

     

    Date of Birth
    For example, 15 3 1984
    Are you a registered patient of Midway Surgery?
    Would you like your details to be given to Carers in Herts in order to get more information and advice? (optional)

  • Details of the Person I Care For or The Person Caring For Me

    The details below are for :-
    Date of Birth
    For example, 15 3 1984
    Is this person registered as a patient of Midway Surgery?
    Would you like this person's details to be given to Carers in Herts in order to get more information and advice? (optional)

  • Declaration

    This form collects the following details for you and the person caring for you or being cared for by you:

    • name
    • date of birth
    • email
    • other personal information and medical details.

    This declaration is to confirm that you and/or the person you are caring for or the person caring for you are registered with the practice, and consent to be contacted by the practice and for the practice and our partners in the NHS to update the medical record for you and the person you are caring for or the person caring for you.

    Please read our privacy policy to discover how we protect and manage your submitted data.

    I give consent to having my details, as entered in this form, to be recorded as a carer in the medical records of the person I care for. I also give consent to be contacted by the practice and for the practice and our partners in the NHS to update the medical record for the person I care for.
    I give consent to having the details of the person caring for me, as entered in this form, added to my medical records as a carer. I also give consent for the person caring for me to be contacted by the practice and for the practice and our partners in the NHS to update my medical record.

  • Additional support and information

    Tel - 01992 586969

     

    • Hertfordshire Adult Care Services - over 18 year olds

    https://www.hertfordshire.gov.uk/services/adult-social-services/carers/carers.aspx

     

    • Children's social care in Hertfordshire

    https://www.hertfordshire.gov.uk/services/childrens-social-care/childrens-social-care.aspx

     

    Tel - 0300 777 0707

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