Carers Assessments Prompts

We have developed a set of prompt questions to help you prepare for your Carers Assessment.

Once you have completed the form below, you will receive an email with your responses which you can use when you have your Carers Assessment.

Please note that this is for your use only – Carers Leeds will not contact you as a result of completing the form.

If you want to talk to someone at Carers Leeds about being referred for a Carers Assessment, please contact our Support Line on 0113 380 4300

Your information is used in accordance with our privacy policy.

Carers Assessment Prompt Questions

I’m happy to share my information and have read the Privacy Policy.

I agree

Your Email

So we can send you a copy

Your Name

And I am (optional)

Years Old

I care for my (optional)

(eg husband, wife, son, daughter, mum, dad, partner)

The condition that best describes the person I care for is (optional)

(eg physical condition, mental ill-health, disability, frailty, dementia, sensory impairment, genetic condition, old age, or alcohol/substance misuse).

These are the caring tasks that I do: (optional)

(eg helping with personal needs such as washing, dressing and using the bathroom, emotional support, managing finances, helping someone with practical activities such as shopping, ensuring someone is safe from harm).

These are words or phrases that describe how I feel: (feel free to use words or phrases that describe a bad day!) (optional)

This is how I feel caring affects me: (optional)

eg does it leave enough time for you? Do you often feel drained or lonely or frustrated? Do you get enough sleep? Do you get back ache from lifting someone regularly? What things are you struggling with? What things can’t you do anymore? Is balancing care and work challenging?)

These are things that I think might help make things easier: (optional)

e.g. having a break or some ‘me’ time, help around the house, getting into or back to work, having an emergency plan, extra support for the person I care for)

These things are important to me: (optional)

(e.g faith or religion, interests, hobbies etc)

Carers Assessments Prompts

Carers Assessment Prompt Questions

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