Skip to main content
  • Language
    • Afrikaans
    • Albanian
    • Arabic
    • Armenian
    • Azerbaijani
    • Basque
    • Belarusian
    • Bengali
    • Bulgarian
    • Catalan
    • Chinese (Simplified)
    • Chinese (Traditional)
    • Croatian
    • Czech
    • Danish
    • Dutch
    • Esperanto
    • Estonian
    • Filipino
    • Finnish
    • French
    • Galician
    • Georgian
    • German
    • Greek
    • Gujarati
    • Haitian Creole
    • Hebrew
    • Hindi
    • Hungarian
    • Icelandic
    • Indonesian
    • Irish
    • Italian
    • Japanese
    • Kannada
    • Korean
    • Lao
    • Latin
    • Latvian
    • Lithuanian
    • Macedonian
    • Malay
    • Maltese
    • Norwegian
    • Persian
    • Polish
    • Portuguese
    • Romanian
    • Russian
    • Serbian
    • Slovak
    • Slovenian
    • Spanish
    • Swahili
    • Swedish
    • Tamil
    • Telugu
    • Thai
    • Turkish
    • Ukrainian
    • Urdu
    • Vietnamese
    • Welsh
    • Yiddish
  • 0121 568 4390
  • Font Size
    • Increase Font Size
    • Decrease Font Size
    • Reset Font Size
Darlaston Health Care
Search
Show Main Menu
  • Home
  • Appointments
  • Prescriptions
  • Services
    • Carers
    • Clinics
    • Fit notes & Sick notes
    • Join the Practice
    • NHS App
    • Non NHS Work
    • Patient Record
    • Proxy Access
    • Self-Referrals
    • Test Results
    • Update Your Clinical Record
    • Update your contact details
    • Services Index
  • Surgery Information
    • Friends and Family Test
    • News
    • Opening Times
    • Our Team
    • Patient Participation Group
    • Policies
    • Practice Leaflet
    • Practice Performance
    • GP Earnings
    • Suggestion & Complaints
    • Training
    • Surgery Information Index
  • Health Information & Advice
    • COVID-19 & Flu
    • Domestic abuse: how to get help
    • Find your NHS number
    • Health A to Z
    • Live Well
    • Medicines A to Z
    • Useful Links
    • Health Information & Advice Index
  • Contact Us

Carer Questionnaire

Do you look after someone?

Does someone look after you?

A Carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.

If you are a Carer, or you have a Carer, it is important that you inform the surgery so we can update our records.

It is important we hold complete and up-to-date information so we can provide the best level of care possible. If your information changes, please make sure you let us know. As your GP, we treat confidentiality very seriously and will never share your information with any other organisation without your prior consent.

Carers Personal Details (To Be Completed By The Carer)


DD/MM/YYYY
Find my NHS Number (opens in new window)

Are you registered at our surgery?
Patient Being Cared For (To Be Completed By The Patient)

DD/MM/YYYY
Find my NHS Number (opens in new window)
Is the patient registered at our surgery?
Enhanced Summary Care Record (To Be Completed By The Patient)

The Summary Care Record (SCR) is an electronic record of important patient information, created from GP medical records. It can be seen and used by authorised staff in other areas of the health and care system involved in the patient’s direct care. Access to SCR information means that care in other settings is safer, reducing the risk of prescribing errors. It also helps avoid delays to urgent care. If you are registered with a GP practice in England your SCR is created automatically, unless you have opted out.

As a minimum, the SCR holds important information about; current medication, allergies and details of any previous bad reactions to medicines, your name, address, date of birth and NHS number. We are encouraging patients to opt in to enhancing their SCR to provide other health care professionals with a better understanding of your history. Enhancing your SCR would include the following information;

  • Significant medical history (past and present)
  • Reason for medication
  • Anticipatory care information (such as information about the management of long term conditions)
  • Communication preferences
  • End of life care information and Immunisations

Do you consent to your Summary Care Record being enhanced?

Privacy Protection

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 and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


Local Services

Site

  • Sitemap
  • Back To Top

About

  • Disclaimer
  • Website Privacy
  • Website Accessibility
  • Cookies
  • Content Attribution

Social

  • Facebook

Contact

Darlaston Health Care

Darlaston Health Centre, Pinfold Street, Darlaston, West Midlands, WS10 8SY

  • 0121 568 4390
© Neighbourhood Direct Ltd  2025
Website supplied by Oldroyd Publishing Group

Loading...

Local Services