Carers survey

By taking part in this survey it helps us identify our carers which in turn will enable us to offer support and share information with you.  Your personal details will be used to update your medical record to record you as a carer.  Thank you.

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* 1. Do you look after someone who can't get by without your help?  If you are an unpaid carer who provides care and support to a partner, relative, friend or neighbour who wouldn't be able to get by on their own, we'd really appreciate your answers to the questions below.  Your answers will tell us how best we can support you as a carer, both now and in the future.

Please tell us your age by ticking the box at the side of the age ranges

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* 2. More about you, please tick any that apply

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* 3. Whilst being a carer have you ever

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* 4. Please let us know about any other suggestions you feel may help you as a carer.

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* 5. In order for us to ensure you are recorded as a carer, if you are happy to, please leave your name and date of birth. 

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