Request Information and Support

Looking after someone can bring challenges as well as rewards. Whether you’re looking for information, wellbeing opportunities, financial guidance, connections with other carers, or simply don’t know where to start, we’re here to support you. 

Why are we asking these questions?  

We know there are quite a few questions in this form. The information you provide helps us understand your caring situation, offer relevant information and opportunities, and avoid asking you to repeat the same information later. It also helps us understand who we’re supporting and improve services for carers across East Kent. 

What would you like more information about? 

Every caring situation is different. These are some of the areas where we may be able to help. Please select any topics you would like more information about.

Information and Guidance
Helping you find the right information, services and support.

Wellbeing and Time for Me
Activities, groups and opportunities to take a break from caring and focus on your own wellbeing.

Money and Financial Guidance
Information and guidance on benefits, grants and other financial support.

Connect with Other Carers
Groups and opportunities to meet other carers, share experiences and learn from one another.

Parent Carer Support
Information, guidance and opportunities to connect with other parent carers.

Carers Voice
A carer-led group working together to raise awareness and improve carers' lives across East Kent.

What would you like more information about? (Please select all that apply)

• Information and Guidance
• Wellbeing and Time for Me
• Money and Financial Guidance
• Connect with Other Carers
• Parent Carer Support
• Carers Voice

About You

Tell us a little about yourself so we can provide relevant information and better understand who we are supporting across East Kent.

I am:

• An unpaid carer
• A parent carer
• A professional
• Family member or friend
• Other

Name *

First

Last

Date of Birth

Gender

• Male
• Female
• Non-binary
• Prefer not to say

Ethnic Background (optional)

• White: English/Welsh/Scottish/Northern Irish/British
• White: Gypsy, Romany Or Traveller
• White - Irish
• White: Any Other White Background
• Asian/Asian British: Bangladeshi
• Asian/Asian British: Chinese
• Asian/Asian British: Indian
• Asian/Asian British: Pakistani
• Asian/Asian British: Any Other Asian Background
• Black/Black British: African
• Black/Black British: Caribbean
• Black/Black British:Any Other Background
• Mixed: White And Asian
• Mixed - White And Black British Other
• Mixed - White And Black Caribbean
• Mixed: Any Other Mixed/multiple Ethnic Background
• Mixed: White And Black African
• Other: Arab
• Other: Any Other Ethnic Group
• Ethnicity Unknown
• Prefer Not To Say

Address 1

Address 2

Town/City

Postcode

Email

Phone

How would you prefer us to contact you?

• Email
• Telephone
• Text Message

Your Caring Situation

Understanding your caring situation helps us provide information that is most relevant to you.

you (optional) care

What is your relationship to the person you care for?

• Partner or spouse
• Parent
• Child
• Other family member
• Friend or neighbour
• Other

What is the gender of the person you are caring for?

• Male
• Female
• Non-binary
• Prefer not to say

Does the person you care for live with you?

• Yes
• No

What is the date of birth of the person you care for

Does the person you care for have any of the following? (Please select all that apply)

• Physical disability
• Learning disability
• Mental health condition
• Dementia
• Long-term health condition
• Autism
• Sensory impairment
• Other
• Prefer not to say

Do you care for anyone else?

• Yes
• No

Tell Us a Little More

Please tell us about your situation, what has prompted you to get in touch, or what information you're looking for.

Tell Us a Little More (Free Text)

How would you describe the impact of your caring role on your life?

• Low impact
• Moderate impact
• High impact
• Very high impact
• Caring impacts every aspect of my life

Keeping in Touch

Would you like to hear about activities, events, opportunities and updates from Carers Support East Kent?

Would you like to hear about activities, events, opportunities and updates from Carers Support East Kent?

• Yes, please keep me updated
• No, thank you.

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Privacy Notice

To provide you with information and support, we need to collect some information about you and your caring situation. This information will be stored securely and used to help us understand your needs, provide relevant information and improve our services for carers.

The lawful basis we use to process your information is legitimate interest.

We will not usually share your information without your permission. However, we may be required to share information without your consent where there is a legal obligation, safeguarding concern, emergency, or risk of serious harm.

We may identify other organisations, services or sources of support that could help you. We will always ask for your consent before making a referral.

For more information about how we collect, use and protect your information, please read our https://carersek.org.uk/about-2/policies/privacy-policy/ Privacy Notice .

Please confirm:

• I have read and understood the Privacy Notice and understand how my information will be used.
• I would like Carers Support East Kent to contact me about my enquiry and the areas I have selected.

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