Informing Your GP Surgery if You Look After Somebody

Informing Your GP Surgery if You Look After Somebody

If you are a child or an adult who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without your suppport, you are a carer.  

Please complete this form and hand it, or send it to your GP Surgery, who will record in your notes that you are a carer.  This can help your surgery provide you with arranging repeat prescriptions, Flu immunisation, annual health checks and arranging apppointments which fit in with your caring role.  

 

  • About me (carer)

  • My Full Name

  • NHS No (if known)

  • My Date of Birth

    DOB
    For example, 15 3 1984

  • My address

  • My contact phone number

  • My relationship to the person cared for

  • Person Cared For

    ONLY COMPLETE THIS SECTION IF YOU ARE BOTH REGISTERED AT KINGS MEDICAL CENTRE

  • Full Name

  • Date of Birth

    DOB (optional)
    For example, 15 3 1984

  • Address

  • Phone Number

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Page last reviewed: 24 December 2025
Page created: 24 December 2025