Register a Carer

We maintain a Carer’s Register to ensure those with significant unpaid caring responsibilities receive priority health services, such as vaccinations and annual health checks.

To ensure our records remain accurate and that we can offer you the correct support, please complete the details below.

We will periodically send you a link to this form to keep your carer status updated; please note that if you do not complete these updates, or respond to our review requests, we may remove you from the carers register.

It is your responsibility to ensure the surgery has your up-to-date contact details to receive these notifications.

Carer Details

Name *

Date of Birth *

Phone Number *

Email Address *

Address *

Postcode *

Details of Person Being Cared For

Full Name of the person you care for *

Date of Birth *

Address *

Postcode *

What is your relationship to the person being cared for? *

Which GP Surgery are they registered at? * (Please type 'Harwood Group Practice' or the name and town of their current surgery) *

Consent and Future Reviews

Do you have a "Carer’s Emergency Plan" in place? *

Yes No

Do you consent to being contacted annually for a Carer’s Health & Wellbeing Review? *

Yes No

Do you give consent for us to record your name as a Carer on the medical record of the person you care for (if they are a patient here)? *

Yes No

Agreement: I confirm that the information above is correct and I agree to notify the surgery if my caring role ceases. *

I Agree

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data. *

I consent to the practice collecting and storing my data from this form.

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Page last reviewed: 26 March 2026
Page created: 18 November 2025

Register a Carer

Register a Carer

Further Information