Register With Us

Select the hospital you are registering from *Diana Princess of Wales Hospital (DPoW)Scunthorpe General Hospital (SGH)

Your full name *

Contact telephone number *

Your E-Mail Address

Your full address including postcode *

Your relationship to the person you care for: *WifeHusbandParentBrotherSisterNeighbourFriendGrandparentSonDaughterAuntUncleOther

If you answered other to the question above, please specify:

Name of the person you care for *

Full address of the person you care for, including postcode *

Please tell us a little bit about your caring role (if you prefer not to in this form, we will speak to you about it over the phone when we call to complete your registration)

To help us deal with your request, please select one of the following: *I am OK- My Caring role is manageable. I just need information about services and updatesI am COPING- My Caring role is stable but I have some worries about the futureI am CONCERNED- My Caring role is difficult and impacting on meI am STRUGGLING- My Caring role is becoming too much to manageI am OVERWHELMED- My Caring role is in crisis- I can no longer cope