Form _ Adult Carer self referral

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If you are aged 18 or over, and would like support from Carers Link please complete this registration form.  The form gathers some personal details which we will store so that we can communicate with you. Access to this information is restricted to those who need to know. You can find out more about how we store and deal with your information in our Privacy Policy.

1. About you

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2. About your caring

If you care for more than one person, please tell us about the person you care for the most, or whose caring causes the most issues. We will then get details of the other person/ other people when we speak to you.

3. What does your caring involve?

Help with medication
Help with personal care or feeding
Help with moving and handling
Help with domestic tasks
Help with transport
Providing emotional support
Monitoring safety
Financial responsibilities
Assisting with communication
Help with appointments
Legal responsibilities e.g. Guardianship/ Power of Attorney
Other

4. Does caring negatively impact on any of the following?

Your health
Your emotional wellbeing
Your finances
Your life balance
Feeling valued
Future plans
Employment or education
Living environment
Social opportunities
Your confidence
Other

5. About the person you care for

6. Consent Form - please read the following carefully.

We need this information so that we comply with General Data Protection Regulations (GDPR). This legislation gives you more rights, and places greater obligations and stricter controls on organisations.

Your consent to store

Carers Link requires your consent to store your information. We do this so that we can communicate with you about activities and services that may be of interest. We also store information so that you do not have to repeat your story each time you contact us, and so that we can properly advocate on your behalf or provide any support for your caring role. For this reason, we also collect some information about the person you care for and we seek your permission, on their behalf, to store this information. All information is restricted in access (need to know) and held securely in a treble password-protected database. We will never, ever, sell your details to another agency, and we will only ever share your information with your permission unless required to do so by law. Only anonymised data is used for statistical monitoring. You can read our full Privacy Policy at https://carerslink.org.uk/download/privacy-policy-for-carers/. Any updates or changes to the policy are announced via our newsletters.

This section only applies if you think you will require advocacy support which could include contacting the school, council, social work or any other agency on your behalf.

We will check with you each time you ask us to make a new referral and seek your verbal, written or text consent depending on the level of information that you require us to share. We will only ever share information without your consent if we believe there is a risk of harm to a child or vulnerable adult.
Please select form the options below

7. Your communication preferences

From a practical point of view, it is helpful if we can contact you using a variety of methods. For example, sometimes a quick phone call or email is all that is required, whereas at other times a letter may be more appropriate.

8. Finally, we can also provide information about activities that you may find of interest or useful. Please choose from the options below:

Weekly e-bulletin by email
What's On monthly update by email
Lowdown 6 monthly newsletter by email
Lowdown 6 monthly newsletter by post

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Carers Link is a Registered Charity NO. SC034447 and Registered as a Company Limited by Guarantee Number 270702