Carer Information

It’s important that everyone who works here at Farnham Dene knows you are a carer so that we can offer you help and support if you need it. Anyone who looks after a friend or family member who cannot manage without them, and is unpaid, can register. This includes carers under the age of 18.

If you are a carer, please complete this form below.

Tell us about yourself

First Name *

Last Name *

Home address *

Postcode *

Date of Birth *

Phone Number *

Email Address *

Relationship to the person you care for *

Do you have a Lasting Power of Attorney? *

Please state which type of Lasting Power of Attorney is in place *

Are you happy for us to send your details to the local carers support service? *

Have you or the person you care for ever served in the Armed Forces? *

Details of Person being cared for

First Name *

Last Name *

Date of Birth *

Home address *

Phone Number *

Age of the person you care for?

Nature of the condition/disability of the person being cared

Is this person registered at the Farnham Dene Medical Practice? *

Are you in receipt of carers allowance? *

Are there any other carers in the household?

What additional support do you feel you need?

Further details on Carer Support can be found here.

I give my consent to the practice to contact me

Please specify

By Email

By Phone

Please tick this box if you are happy for your details to be shared with Action for Carers Surrey/Surrey Independent Living Council. They will then contact you to discuss the support and assistance they can provide.

I want a copy of the contents of this form to be emailed to me

I confirm that the patient being cared is a registered patient at Farnham Dene Medical Practice *

By submitting this form, you are giving consent for the Farnham Dene Medical Practice to keep a record of your contact details on the cared for person’s medical records.

Please be aware that should any of the above details change, it is your responsibility to notify the Farnham Dene Medical Practice of the changes.

Fields marked with an asterisk (*) are mandatory

FAQs

Am I eligible as a carer?

A carer looks after a family member, friend, partner or neighbour who needs support due to illness, disability or old age. The help carers give is unpaid, though you may still receive Carer’s Allowance or other benefits. You do not have to care full time to receive Carer’s Allowance or live with the person you care for to be a carer.

I don’t live in the same borough/county as the person I care for – where do I go for help?

It is the duty of the local authority (council) where the person you care for lives to assess their care and support needs and your needs as a carer. For example, if the person you care for lives in Sutton, the London Borough of Sutton would be responsible for assessing their support needs and offering you a Carer’s Assessment.

What is Carer's Allowance and how do I claim it?

Carer’s Allowance is the main benefit for carers. It is currently £66.15 a week from April 2019. The rate generally changes each financial year. To qualify for Carer's Allowance, you must:

Be aged 16 or older.
Care at least 35 hours a week for someone who is receiving a qualifying disability benefit.
Not be in full-time education (over 21 hours a week).
Not earn over £123 a week (after some allowable deductions such as tax and National Insurance contributions).
Satisfy UK presence and residence conditions

Where could I receive more details on Carer Support?

For more information on the support available to you, please click on the links below or come in and speak to a GP.

Patient Consent To Share Information With Their Carer

Please download the consent form here.

Useful Information

Carers Week Newsletter June 2022

NHS Social Care and Support Guide

Action for Carers Surrey

Surrey Young Carers

Surrey Information Point

Hampshire County Council Adult Social Care

Hampshire Young Carers Alliance