Information Sharing Consent

Adult Carers - Information Sharing Consent

"*" indicates required fields

You have been referred to Barnet Carers as being an unpaid carer. As part of our support, we are required to ask you for your consent for your contact details to be shared.

Please complete the short form below indicating your information sharing preferences.

Name of Carer*

First Last

Date of Birth*

Informing Your GP

We can automatically inform your GP that you have been registered with Barnet Carers as a carer. Informing your GP that you are a carer may enable additional services and benefits to be offered to you such as free influenza vaccinations or longer appointments. Please tick if you consent to us informing your GP. We will only send basic details to your GP (name and address).

Please select your GP Surgery*

Barnet Leisure Pass

As a carer registered in Barnet you are able to get a FREE Leisure Pass which will give you access to local leisure centres, free swimming and discounted services. Please tick below if you would like to be automatically registered for a Leisure Pass. If you consent we will send details of your name and address and contact details to Better Leisure in order to facilitate your leisure pass - those details will not be used for any other purpose.

Please note: On submission of this form, there is a 2 week administrative period necessary in which details are shared and the Leisure Pass is created and emailed.

Please enter your postcode below and click on the Lookup Postcode button

Address*

City*

Postcode*

Email Address*

Contact Number*

Gender*

Ethnicity*

Do you have a health or medical condition that impacts your caring role?*

Yes

If Yes, what condition are you affected by

Information Sharing Consent

Adult Carers - Information Sharing Consent

Informing Your GP

Barnet Leisure Pass

Barnet Carers

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