Carer Registration

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Carers Identification and Consent Form

Do you look after someone - a relative, friend or neighbour who is ill, frail or disabled and is unable to or has difficulty looking after themselves? Do you give support to someone who has mental health needs or misuses alcohol or drugs?

If you are, that means you are a carer and by registering that you are a carer with the Practice it could mean that we are able to offer you more support.

Please complete the following form.

Carer Details
Please double check you've entered the correct email address
Details Of Person Being Cared For

If the person who is cared for is not registered at Gloucester Road Medical Centre, please ensure that their own GP is aware they have a carer.

Access Records

In some circumstances, it can be useful for your carer to be able to access your medical information. If you consent to this happening, please read below and sign if you are happy with this statement.

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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