Adult Carer Registration Form

Notice

If you have any questions or would like to speak to an Adult Carers Support Worker before completing this form, please contact the team on 020 8867 2380 or email support@richmondcarers.org

Save and Resume Later

Information about you

Title *

Pronouns *

Your name *

First

Last

Contact details *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Mobile *

Home telephone

Email *

Date of birth *

Gender *

Do you consider yourself to have a disability or long term health condition? *

Religious Group *

Sexual Orientation *

Ethnic Group *

Please can you tell us what support, advice or information you may need at this present time from Richmond Carers Centre:

Our carer support service includes information and advice, emotional support, wellbeing service, social groups, leisure and activities programme, information workshops, financial advice and access to grants.

We send regular service and information updates to carers via email. If you would like to receive information about Richmond Carers Centre’s services, please consent below: *

Please note if you respond No then you will be unable to receive information about our regular services, information and advice, activities and workshops

Save and Resume Later

Information about the person you care for

Name of the person you care for *

First

Last

Date of birth *

What is their main illness, disability or condition? *

What is their relationship to you? *

Do they live with you? *

If no, please provide their postcode? *

Do they live in the London Borough of Richmond upon Thames? *

Is anyone else providing care and support to the person you are helping? *

Yes
No - I am the sole person providing care

Have you had a Carers Assessment?

Carers Assessment – if you are caring for someone aged 18+ you are entitled to a carers assessment by the local authority of the person you care for. This looks at the impact caring has and what support is available to help you in your caring role and to live your life well. It will cover many aspects of your life including health and wellbeing, ability to work and impact on relationships. The assessment will determine if you are eligible for any support from the local authority. If you do not meet eligibility for local authority support they will provide you with information and advice on how to access support from other local services for carers.

Online self-appraisal - https://www.richmond.gov.uk/carers_self_assessment

Contact details for Adult Social Care First Contact Team – 020 8891 7971 / adultsocialservices@richmond.gov.uk

Save and Resume Later

Notice

Information about you

Information about the person you care for

Refer another unpaid carer to Richmond Carers Centre

Disclaimer

Contact our support team on 020 8867 2380