Consent

Carers Matter Norfolk supports adults, over 18 years, who care for other adults living in Norfolk. If you are under 18 and caring for an adult, please visit:

Home - Carers Matter (youngcarersmatternorfolk.org)


 If you are over 18 and caring for a child, please visit:

Getting Help


By registering with Carers Matters Norfolk, you are confirming you are happy for us to use the information provided to process your sign up and contact you to progress your registration. You are also consenting to us sharing your data as needed with other carefully selected health services or organisations in order to provide the service to you. Further information on how we handle your data can be found in the Privacy Notice on our website


Privacy Policy - Carers Matter Norfolk : Carers Matter Norfolk


Please think about the last few months and then answer the questions below as accurately and honestly as you can. Your answers will help us work out the type of support you need. We are aware that your needs & circumstances may change suddenly.
Carer Details




What is your First Name


Format ##/##/####




Contact Details

Please only enter numbers into the phone number fields (do not include spaces or other symbols).













Demographic 






GP Surgery Details



Select your primary health condition

Information about the people you care for

All the people you care for must live in Norfolk and also you must have permission to give us their details


                                          
Cared For Details



Format ##/##/####










                                          
Details of Second Cared For



Format ##/##/####










                                          

Cared For Details 3

Details of Third Cared For



Format ##/##/####










                                          
Employment Status



Finance

Finances We could all do with some extra money, but sometimes caring for another can negatively impact our finances. You may be incurring additional costs because you’ve had to give up work, buy special food or equipment or travel more to visit the person that you care for. Do you know if you are receiving all of the benefits you and your cared for are entitled to, to help with these additional costs.



Safety & Caring Role

Mental health

Mental and emotional health and wellbeing describes how we think, feel and relate to ourselves and others and how we interpret the world around us. Having good emotional health affects our capacity to manage, communicate, and form and sustain healthy relationships. Think about how your caring responsibilities impact the way you feel day to day, it is perfectly normal to feel sad or frustrated and we aren’t here to judge, we can talk through ways to help you to manage your emotions.



Physical Health This refers to how you feel physically, it can mean anything from disease or illness, lifestyle, fitness levels, diet or habits such as smoking or drinking. Does your caring role impact your physical health, are you struggling to lift or carry, are you unable to prepare healthy meals for yourself?


Time for carry out day to day activities Sometimes it seems like there aren’t enough hours in the day, but we know that for carers it can be particularly difficult to fit everything in. In this section we are asking you to think about the time you have to spend on things that you enjoy, meeting up with friends, going for a coffee or taking part in a hobby or activity that you enjoy. Are you able to carry out day to day activities like shopping, cooking, cleaning or attending medical appointments




Physical Safety of the person you care for Is the person you care for physically safe, are then prone to falls for example? Do you worry about leaving them alone for extended periods of time because they might hurt themselves?

Your Caring Role



Relationships with friends and family Do you have enough time to spend with your friends and family, do you feel that other relationships are being affected because you are caring for someone. Do you feel that you get the support you need from friends and family?


Accommodation This section is about the suitability of your home in relation to your caring role, does the property have the right equipment or does it need adaptations?





You have decide not to proceed at this time.

Please close this window as you will not be able to submit this form.

If you decide you would like to be registered and recieve support, please either reopen and complete this form, or call us on 0800 083 1148

Consent 




As you do not have consent to share the information for the person / persons you care for we are unable to register you at this time.

If you would like to recieve our Carers Newsletter, please click here to register.

Please close this window as you will not be able to submit this form.



As your cared-for does not live in Norfolk we are unable to support you. Please use the links below to find support for carers in the area your cared-for lives.

Support where you live | Carers UK

Local Carers Support Services Near Me | Carers Trust


Please close this window as you will not be able to submit this form.


Thank you for completing the form -

Please press submit to complete the process.

Following submission please expect a phone call from one of our advisors to continue your support journey with us. 

By submitting this form, you consent to your information being used by Carers Matter Norfolk to review and assess the service being provided. Data submitted will be anonymised for benchmarking and reporting to contract commissioners. You can find further information on how we deal with your data in our privacy policy.

Contact Information