Do you look after someone who could not manage without you?
Here at the surgery we are trying to put together a register of all our patients who are caring for others.
The reason for this is to identify the number of Carers in the area to ensure that carers are offered the help and advice that is available to assist and support them in their caring role.
If you are a child or adult caring for someone at home or elsewhere who is ill, frail or disabled and the care you provide is unpaid - YOU ARE A CARER. The term carer should not be confused with that of paid care worker or someone who acts as a volunteer attached to a voluntary orgainisation.
Being a carer counts, please click here for details of other help available.
To Register As A Carer
Please complete the details below, we will send you a carers registration form.
Information submitted through secure forms is used only for the purposes of processing your request. We may
be in touch with you in relation to the information submitted.
All Information submitted through secure forms is secured with a private key known only to the GP practice and is
accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.
This information is not shared with any third party organisations.
This information is retained for up to 28 days.
I consent to my information being used for the purposes described above and wish to submit this online form to
Broad Lane Surgery
71 Broad Lane , Hampton, Middlesex, TW12 3AX.
Should you have any concerns about sending your personal details using the web,
please use one of the alternative methods offered by our organisation.