Registration and referral

If you are a parent Carer (caring for someone under 18) please see our Parent Carer information page

Referrer details

Name of referrer (if applicable)

Telephone:

Email:

Organisation/Role:

Carer details

Name:

Date of referral:

Address

Postcode

Home Telephone

Mobile

Email Address

Date of Birth

Gender

Age

Ethnicity

Marital Status

Dependants

Language Spoken (state preferred language)

GP Surgery and Telephone number

Is the Carer already a member to DCA?

Length of time as a Carer?

Has the Carer ever had a Carers Assessment?

Details of the Cared For 1

Name

Diagnosis/health condition

Relationship to Carer

DOB & Age

Address

Details of the Cared For 2

Name

Diagnosis/health condition

Relationship to Carer

DOB & Age

Address

Other information

Are there any risks identified we should know? (ie animals in property, no lone workers, client hard of hearing, sensitivity towards cared for, etc)

On a scale of 1-5 how stressed or anxious are you/is the carer about the caring situation?

How is health impacted by caring?

Are social care, other agencies or wider family/friends supporting?

What support would improve the caring situation?

Guidance for unpaid Carers to friends or family

Government guidance for those who provide unpaid care to friends or family This guidance is f...

Corona Virus Act 2020 provisions / implications for Care Act 2020

• These p...

Telephone Befriending for Carers During Covid-19

Derbyshire Carers Telephone Befriending Telephone Befriending at DCA is a regular friendly ca...

Registration and Referral

Guidance for unpaid Carers to friends or family

Corona Virus Act 2020 provisions / implications for Care Act 2020

Telephone Befriending for Carers During Covid-19