Register with Carers Bucks

Are you looking after someone who cannot manage without you because they are ill, frail or disabled? If so, you are a carer and Carers Bucks is here for you.

Complete our registration form below to register with Carers Bucks and make use of our free services, including information, advice, guidance, emotional support and a listening ear. Once we have received your form, one of our Support Workers will follow up with a telephone call which will give you the opportunity to discuss your caring role in detail. The Support Worker will work with you to resolve any issues or problems you may have in your caring role. If you have an urgent request please highlight this on the form.

For information on how Carers Bucks stores and uses your personal data, please see our Privacy Notice.

    First name (required)

    Last name (required)

    Your date of birth (required)

    Are you aged 18+? (required)
    If you are aged 17 or below, please fill in our Young Carers referral form.


    Is your gender identity the same as it was given at birth?

    Sexual Orientation


    House name/no. (required)

    Street (required)

    Postcode (required)

    Your email address (required)

    Phone number (required)

    Who do you care for? (required)

    What is their illness/disability? (required)
    ElderlyDementiaMental IllnessPhysical DisabilityLearning DisabilityOther

    Further information request

    Are you or the person you care for currently in hospital?

    How did you hear about Carers Bucks? (required)