Register as a Caregiver

A woman caring for an older lady.

If you consider yourself to be an unpaid caregiver living in Gateshead and would like to access support, please complete the form below to register with us.


Self-Referral Form – Caregivers Connected Gateshead

Your Details

Name(Required)
Is the gender you identify with the same as your sex registered at birth?
Address(Required)
DD slash MM slash YYYY

Emergency Contact Details

Name of Emergency Contact

The person you care for

Name(Required)
Address(Required)
DD slash MM slash YYYY

Accessing Support

What services and support would you like to receive from us?