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Ling House Medical Centre Providing NHS services
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  • 'We're right on track,' says Streeting as key target for hospital waiting times hit14 May 2026 15:26Government his its interim target of 65% of patients in England being treated within 18 weeks.
  • Posh sandwich has more salt than nearly five cheeseburgers13 May 2026 11:57Action on Salt & Sugar said people should not be exposed to a "hidden health risk every time they buy lunch".
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  • How are countries responding to hantavirus?13 May 2026 09:36The UK, US and EU are asking all citizens returning home from the virus-hit MV Hondius to self-isolate for about six weeks.
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Home > Carer Questionnaire

Carer Questionnaire

Do you look after someone?

Does someone look after you?

A Carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.

If you are a Carer, or you have a Carer, it is important that you inform the surgery so we can update our records.

It is important we hold complete and up-to-date information so we can provide the best level of care possible. If your information changes, please make sure you let us know. As your GP, we treat confidentiality very seriously and will never share your information with any other organisation without your prior consent.

Carers Personal Details (To Be Completed By The Carer)


DD/MM/YYYY
Find my NHS Number (opens in new window)

Are you registered at our surgery?
Patient Being Cared For (To Be Completed By The Patient)

DD/MM/YYYY
Find my NHS Number (opens in new window)
Is the patient registered at our surgery?
Enhanced Summary Care Record (To Be Completed By The Patient)

The Summary Care Record (SCR) is an electronic record of important patient information, created from GP medical records. It can be seen and used by authorised staff in other areas of the health and care system involved in the patient’s direct care. Access to SCR information means that care in other settings is safer, reducing the risk of prescribing errors. It also helps avoid delays to urgent care. If you are registered with a GP practice in England your SCR is created automatically, unless you have opted out.

As a minimum, the SCR holds important information about; current medication, allergies and details of any previous bad reactions to medicines, your name, address, date of birth and NHS number. We are encouraging patients to opt in to enhancing their SCR to provide other health care professionals with a better understanding of your history. Enhancing your SCR would include the following information;

  • Significant medical history (past and present)
  • Reason for medication
  • Anticipatory care information (such as information about the management of long term conditions)
  • Communication preferences
  • End of life care information and Immunisations

Do you consent to your Summary Care Record being enhanced?

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 and is accessed over a secure connection by nominated staff. We have 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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Ling House Medical Centre

49 Scott Street, Keighley, West Yorkshire, BD21 2JH

  • 01535 605747
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Local Services
Residential/
Nursing Care
Car Service
& Repair
Mobility Aids
& Equipment