Personal Information and Contact Details
We need to collect some basic personal details from you such as your date of birth and address. These will only be used to provide you with support that is identified as part of this carers assessment.Please Note
A home telephone number or a mobile number is required so that we can communicate with you.Language and Communications
We want to find out a bit more about the best way of communicating with you. The more we know the easier it is.Please Note:
You have selected Email as your preferred communication method but have not entered an Email address for us to contact you.
The Person You Care For
Now we are going to ask you some questions about the person you care for. This is so that we can get a good idea of the care you are offering and can make sure that your carers action plan fits you as well as it can.Your Caring Role
Now we are going to ask you some questions about the support you provide to the person you care for.We need to know if you have any concerns about your personal safety when carrying out your caring responsibilities. Remember, this assessment is confidential. However, if you tell us that you do not feel safe, we can help you by sending a Safeguarding alert to your local authority.
Your Wellbeing
Please tell us about how your caring role affects your general health and wellbeing. For example, you may want to tell us if you have any concerns about your health, if you have any diagnosis / registered disability, if your caring role interferes with your sleep, affects your mood or how you feel, or causes you any physical pain or strain.Anxiety Related to Your Caring Role
We would like to understand any issues that you may be experiencing related to your caring role.Your Family and Personal Relationships
Your Family and Personal RelationshipsHobbies and Interests
Home Environment
Please tell us if your caring role is preventing you from maintaining your household tasks.Paid Work, Training and Volunteering