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Are You A Carer?

Do you look after a family member or friend who is unwell, disabled or frail?

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If so please complete this form. Once you are added to our list of carers we will know about your busy life as a carer, which can affect your health. We can also try and be flexible with appointments etc as we will know about your commitments.

Your Details
Title
Details of Person Being Cared For
Is the person you care for a patient at The Rigg Milner/Corringham Health Centre?
Please note that we will not respond to any medical information received through the survey.

Thanks for registering as a carer.

Note that by using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your comment.

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Your IP address will be sent with your communication. In rare cases where abuse or criminal activity can be shown to have taken place this may be used by the authorities to trace you.

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