If you would like to register with Carers Bucks to make use of our free services please complete the form below.

Once we have received your form we will post you an information pack. This will be followed up by a telephone call from one of our Support Workers who 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.

First Name (required)

Last Name (required)

House Name/No (required)

Street (required)

Postcode (required)

Your Email (required)

Phone Number (required)

Best Time To Call You

Who Do You Care For?

What Is Their Illness/Disability?
ElderlyDementiaMental IllnessPhysical DisabilityLearning DisabilityOther

Further Info Request