Carer Identification Letter to GPs

Informing your GP that you are a carer may enable additional services and benefits to be offered to you such as free influenza vaccinations or longer appointments.

Should you wish us to help, please complete the form below and we can send you a letter informing your GP that you are a registered carer, with Harrow Carers.

Carer Identification Form - GPs

"*" indicates required fields

Please complete and submit the form.

Your Details

Your Name*

Prefix First Last

Your Address*

City*

Postcode*

Your Email Address*

We will email you a copy of the drafted letter informing your GP that you are a registered carer.

Primary Contact Number*

NHS Number (if known)

I confirm that: (Please select all that are applicable)*

I am the main carer for a person who would be at risk if I were to fall ill.

I receive Carer’s Allowance.

I am happy for a member of the GP practice team to ask me about this person, and the care I provide if needed.

GP Details

Please select your GP Surgery from list below. If listed, it will auto-complete the address details.

Your GP Surgery*

If your surgery is not shown in list, please select Not Listed from the drop-down menu and complete address details below.

Surgery Name (if not listed above)*

Surgery Address*

City*

Postcode*

Carer Identification Letter to GPs

Carer Identification Form - GPs

Your Details

GP Details

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