The Dicconson Group Practice

The Hub: 01942 482848

Registration and Referral Form for Unpaid Carers


Please complete this form and we can make a note on your medical record that you are a carer and with your permission refer you to Wigan and Leigh carers centre for free confidential advice and support.

If you would prefer to download and handwrite the form, please do so by clicking here. Please then return the form to the surgery at your earliest convenience.

  • Carer details

  • MM slash DD slash YYYY
  • DD slash MM slash YYYY
  • Details of Person Being Cared For

  • MM slash DD slash YYYY

We understand that you are currently providing valuable unpaid care and support to someone who would find it difficult to get by on their own.

Although caring for someone can be very rewarding it can also sometimes be very tiring and stressful or make it harder to look after your own health and wellbeing.

The person you care for must live in the Wigan borough (pay your council tax to Wigan council) for you to register as a carer with Wigan and Leigh carers centre.

There is more information about help with day-to-day living because of illness or disability on the NHS website.

Date published: 13th November, 2019
Date last updated: 30th July, 2020