(* denotes mandatory fields)
Data sharing consent
In order to support you we need to know some personal information about you and the person you care for, including how we can contact you about services. We need this information to ensure our services and those that other agencies offer you, meet your needs.

We may share information with organisations who fund us, including the local authority and the NHS.  Further details of how we handle your personal information can be found on our website.(Carers in Bedfordshire Privacy Policy).
Adult Registration details
Hidden fields
iTest Records
Test Mode

Form is in Test mode - New Referral notifications are sent to the Test Support Worker user

About the Carer
Referral source
Hidden fields
Marketing Communications
Occasionally we may wish to contact you with information on the charity’s broader activities and services. This may include Carers ID Card offers, job and volunteering opportunities, fundraising activities.

Are you happy to receive information that we believe will interest you on topics like these?
Schooling/College headline information
School/College Contact Details
Support from other agencies

Other information

More information about Young Carers
Does the young person have difficulties in any of the following areas?
Wellbeing of Carer
To help us ensure you get the right support as quickly as possible please think about the last month and answer the questions below as accurately and honestly as you can. The answers you give to the questions will guide us to assess your current level of need in your caring role.  Those carers assessed to have a higher level of need will receive a phone call from a member of our Early Response Team in the next few weeks.  Those assessed to have a lower level of need will receive a phone call in approximately 3 months time.
Once your registration is complete you will receive a welcome pack of helpful information.  You will also be able to access any of our support services e.g. peer support groups and workshops, carers grants, counselling, wellbeing practitioner support, carer discount card etc.  All of this information is available on our website –
We are aware that carer needs change quickly so please do call us if you would like to discuss your situation with a trained support worker or if you have a specific question you would like answered.  We have a member of the support team on duty every day to take calls and emails.  

Please click the number you feel best reflects your situation:

Very good
Stress is defined as a state of mental or emotional strain caused by adverse circumstances.

Very good
Physical health is critical for overall well-being and is the most visible of the various dimensions of health, which also include social, intellectual, emotional, spiritual and environmental health.

Very good
Mental health is an integral part of health; indeed, there is no health without mental health. Mental health is determined by a range of socioeconomic, biological and environmental factors.

Not at all 
Very well
We would like to know how well you are supported by friends and family as a carer.

Not at all 
Very well
We would like to know how well you are managing as a carer in your regular life.


Professional Referrer name and organisation
Details of the person you care for
Diagnosis category
Thank You!
It looks like we already have your details - contact us if you want to update your records or are you need further support.Please contact us on  or call us on 0300 111 1919.
Consent Required
In order for Carers in Bedfordshire to support you we need you to consent to us using your data as described in our privacy policy. To continue with our registration you must select Yes. For further information please call us on 0300 111 1919.