Wiltshire Carer ID Card Professional Referral
Carer Details
Please complete your details to register someone for a Carer ID Card. If there is an issue completing this form, please email us at carerfriendlywiltshire@forwardcarers.org.uk
First Name
Last Name
Email
Phone or Mobile Number
Please check this is correct before submission
x
Carer Postal Address
Please make sure this address is correct before submitting this form as t
his is where we will send the Carer ID Card to
Address Line 1
Address Line 2 (If required)
Town / City
Post Code
Date of Birth
Your Carer ID Card
Please confirm the person you are making this referral for provides care for someone who lives in Wiltshire
Yes
No
Please note, this card is only for Carers who provide care for someone who lives in Wiltshire. If you mark ‘no’ you will be taken to the Self Check section of this form.
x
Emergency Contact Details On Your ID Card
On the reverse of the Carer ID Card we will record emergency contact details, this is the person who should be contacted in the event something happens to the carer. The card will also contain the Wiltshire Adult Social Care Advice and Contact Team contact details. After you have made this referral, the carer will be contacted by Carers Together Wiltshire who will offer them the opportunity to create an emergency plan for the person they care for in the event they are unable to care for them for any reason.
Name of the emergency contact
Contact telephone number
Please make sure this is a number for their emergency contact
x
Photo for ID Card
The Carer ID Card includes a photo which you will need to upload here. The picture needs to be a head and shoulders image that the carer is comfortable using on the front of the card.
Please Attach an Image here
Please tick this box to say that you have read and understood the
privacy policy
Yes, I have read and understood the privacy statement
This service is funded by Wiltshire Council and BSW ICB
Contact Information