The Bovey Tracey & Chudleigh Practice

Carer Registration Form

Please add my name to the register of Carers which will be held by the Bovey Tracey & Chudleigh Practice.

1Your (Carer's) Details

Name

Date of Birth

Address

Best Contact Phone NumberPlease put the number we are most likely to be able to contact you on if required.

Additional Contact Phone Number

2Details Of The Person You Care For

Name

Date of Birth

Address

Your relationship with this persone.g. spouse/child/parent

Their doctor

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Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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