Skip to main content
  • Language
    • Afrikaans
    • Albanian
    • Arabic
    • Armenian
    • Azerbaijani
    • Basque
    • Belarusian
    • Bengali
    • Bulgarian
    • Catalan
    • Chinese (Simplified)
    • Chinese (Traditional)
    • Croatian
    • Czech
    • Danish
    • Dutch
    • Esperanto
    • Estonian
    • Filipino
    • Finnish
    • French
    • Galician
    • Georgian
    • German
    • Greek
    • Gujarati
    • Haitian Creole
    • Hebrew
    • Hindi
    • Hungarian
    • Icelandic
    • Indonesian
    • Irish
    • Italian
    • Japanese
    • Kannada
    • Korean
    • Lao
    • Latin
    • Latvian
    • Lithuanian
    • Macedonian
    • Malay
    • Maltese
    • Norwegian
    • Persian
    • Polish
    • Portuguese
    • Romanian
    • Russian
    • Serbian
    • Slovak
    • Slovenian
    • Spanish
    • Swahili
    • Swedish
    • Tamil
    • Telugu
    • Thai
    • Turkish
    • Ukrainian
    • Urdu
    • Vietnamese
    • Welsh
    • Yiddish
  • (01352) 759163
  • Font Size
    • Increase Font Size
    • Decrease Font Size
    • Reset Font Size
Pendre Surgery
Search
Show Main Menu
  • Home
  • Appointments
    • Appointments
    • Cancel an Appointment
    • Contact Us Online (eConsult)
    • Home Visits
    • Speedy Check-In
    • Telephone Advice
    • Times & Out Of Hours
  • Prescriptions
  • Services
    • Carer Questionnaire
    • Change / Update Personal Details
    • Clinics
    • eConsult Information
    • Immunisations
    • Medicals & Private Work
    • New Patient Registration
    • Other services
    • Sample Drop Off
    • Sickness Certificates
    • Smoking Status
    • Test Results
    • Your Allergies
  • Surgery Information
    • Access - Expectations
    • Audits
    • Communication Consent
    • Consent to discuss your medical records
    • Find us on Facebook
    • Greener Primary Care Wales Scheme
    • News
    • Our Team
    • Policies
    • Practice Area
    • Practice Booklet
    • Practice Training Afternoons
    • SMS Opt Out & Consent
    • Times & Out Of Hours
    • Welsh Speakers
  • Health Information & Support
    • Check your symptoms
    • Common Ailments & Your Local Pharmacy
    • COVID-19
    • Dental & Optometry
    • Health A-Z
    • Info for Children
    • Living and feeling well
    • Mental Health Support
    • NHS 111 Wales
    • Services Near You
    • What service do I need?
  • Contact Us

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.


Local Services
Optician

Site

  • Sitemap
  • Back To Top

About

  • Disclaimer
  • Website Privacy
  • Website Accessibility
  • Cookies
  • Content Attribution

Social

  • Facebook

Contact

Pendre Surgery

Clayton Road, Mold, Flintshire, CH7 1SS

  • (01352) 759163
© Neighbourhood Direct Ltd  2025
Website supplied by Oldroyd Publishing Group

Loading...

Local Services
Optician