Register as a carer form

If you are looking to become a carer or to support a relative or friend, you will need to register as a carer. This is so we can let their GP know that you can access their information. We also need to let the Government know about the number of carers registered at the surgery.

Complete the form below to register as a carer.

GP Carers Identification and Registration Form

Do you look after someone who has a long term health condition or illness, a disability or a mental health issue?

You can be offered information, support and access to services through Caring for Carers at Improving Lives Plymouth. This Form will enable you to be registered with Caring for Carers as a carer and gives us permission to keep your information on file and send relevant information to you in regard to services available to you, including a regular newsletter.

Surgery name

Please write the name of the surgery you are registering at

Your title

Please select your title from the options below

Mrs

Miss

Other

First name

Please enter your first name in the field below

Surname

Please enter your surname in the field below

Your home address

Please enter your home address in the field below

Postcode

Please enter your postcode in the field below

Your date of birth

Please enter your full date of birth in the field below

Your telephone number

Please enter your telephone number in the field below

Your email address

Please enter your email address in the field below

Have you served in the armed forces or did you complete national service?

What is your relationship to the person you care for?

Please tell us if you are related, a friend or other connection.

Important:

Register as a carer form

GP Carers Identification and Registration Form