Edinburgh Carers - managed by Vocal

Carer information

GenderPlease Select...MaleFemaleIdentify as transgender

EthnicityPlease Select...White Scottish White EnglishWhite WelshWhite IrishWhite BritishWhite Gypsy/TravellerWhite PolishWhite Other PakistaniPakistani ScottishPakistani BritishIndianIndian ScottishIndian BritishBangladeshiBangladeshi ScottishBangladeshi BritishChineseChinese ScottishChinese BritishAfricanAfrican ScottishAfrican BritishCaribbeanCaribbean ScottishCaribbean BritishBlackBlack ScottishBlack BritishArabOther mixed/multiple ethnic groupOther

Please tick if carer would like VOCAL Carer Support team to call

Information about the person you care for

ConditionPlease Select...ADHDAIDS/HIVAlcohol misuseAll conditionsAlzheimer’s/DementiaArthritisAsthmaAutismBehavioural difficultiesBrain InjuryCancerCerebral PalsyChildren with additional needsCommunication problemsDiabetesDowns SyndromeDrugs misuseEpilepsyFrail/ElderlyHearingHeartHuntington’s diseaseIncontinenceKidneyLearning disabilityLiverLungMEMental HealthMobilityMSParkinson’s DiseasePhysical disabilityRheumatoid ArthritisStrokeTerminal illnessUndiagnosedVisualOther

Age rangePlease Select...under 1818 to 3536 to 5960 to 6465 to 7475 and over

GenderPlease Select...MaleFemaleIdentify as transgender

Have they had a stay in hospital in last year?YesNo

You do not need the consent of the person being cared for but if you do have it please tick here

Complete if you are making a referral on behalf of a carer

Carers consent obtained

Data protection statement

The information provided in this form will be stored on VOCALs database. This will allow us to let carers know about events, training and other relevant opportunities. We may occasionally contact carers by telephone. We will add carers to VOCALs carer email list (and professionals to the professionals email list). We will not share any personal information with a third party unless required to do so and will always seek to obtain consent first. Information is regularly checked to ensure it is accurate and up to date. If you wish to view the information we hold about you or if you wish your details to be removed, please contact VOCAL using the details below.

Please tick here if you do not wish us to do this