Reg. Charity No: 1132951
Company Registration No: 7025891

19a Lowthian Road
Hartlepool
TS24 8BH
Opening Times: Mon - Thurs 9am till 5pm, Friday 9am till 3pm
Tel: 01429 283095 Like us on Facebook

Location: Home / Registration Options / Register with Hartlepool Carers

Register with Hartlepool Carers

Complete the form below to send your information to Hartlepool Carers. We can then register you in our system and provide you with any care or support you need in order to fulfil your caring responsibilities.

About You


First Name

Surname

Gender

NHS Number
If you are unsure what this is please leave blank

I agree and understand that my contact details will be shared with a third party, if not provided above, in order to obtain my NHS Number only. My contact information will then be destroyed by the third party

Date of Birth

Your Relationship to the Cared For

Ethnicity

Health

Contact Number (Please include area code if a landline)

Are you Comfortable Recieving Text Messages?

Do you have an Answer Phone Where Messages Can be Left?

Email Address

1st Line of Address

Town / City

Ward

Post Code

Are You a Veteran? If so Please Enter Which Armed Forces you where in and the Date you Served

Your GP's Name

Social Workers Name

District Nurses Name

CPN


About the Person(s) You Care For


Please provide Names, Address, Contact Details, Date of Birth etc for the person(s) you are Caring for

Why Does the Person(s) you Care for Need Your Help? Please Include any Daily Requirements / Routines they Need to do

Emergency / Alternative Contact Details for Yourself and the Person(s) you Care for


Hartlepool Borough Council North Tees and Hartlepool NHS Trust Carers Trust Network Partner Hartlepool Now Carers UK