Register a Carer

It is important that we know if you are a carer so that we can make sure you receive information, services and the help that is available. If you are a carer please complete this form. Find out more about carers…

Please Note – once you have submitted this information, any reply or acknowledgement from us will be sent to the email address you provide at top of the form. This response may include personal and sensitive information about you. We therefore strongly advise that you provide a personal email address that only you have access to. If you do not wish for us to communicate with you via email, please do not use this form and call us instead.

Register a Carer

Register a Carer

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Carer Details

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Email Address: *

This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

Phone Number:

Address including postcode:

Details of Person Being Cared For

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Address including postcode:

What relation is the person you care for?

What relation to you is the person being cared for?

Yes

No

Are you happy to be contacted by the Reading and West Berkshire Carers Hub?

Yes

No