Carer or Care Provider concerns or issues


This form is to make Adults' Health and Care aware of any issues you may have with your or someone else's carer or care provider. We would always recommend discussing any issues with the carer or care provider.

Your details
Manually enter your address if you live outside Hampshire, or you cannot find your address
For example: 31 12 1980
Initial questions
Is this about your care? required
Has the individual consented to you making this notification? required
Does the individual have the mental capacity to make this decision? required
Can you confirm this is in the individuals best interest? required
Individual's details
Manually enter the address if the address is outside Hampshire, or you cannot find the address
For example: 31 12 1980
The AS reference can be found on correspondence from Adults' Health and Care
The NHS number will be on any letter or document received from the NHS, such as prescriptions, test results and appointment letters
Manually enter the address if the address is outside Hampshire, or you cannot find the address
Questions
For example: 'the time's my carer comes are wrong' or 'I never know what time my carer is arriving'
Have you discussed this with your carer or care provider? required
For example: 'I want you to speak to the provider'
required