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Reasonable Adjustments Form

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Reasonable Adjustments for Healthcare

The NHS must make it as easy for disabled people to use health services as it is for people who are not disabled. This is called making reasonable adjustments.

It is your right to ask for reasonable adjustments.

This could be the way you are treated or the things that you need when you visit your GP or are in hospital.

If you would like us and other NHS services to offer you reasonable adjustments, please complete and submit this form to the Practice.

All questions marked with a * are mandatory

Personal Details

Please double check you've entered the correct email address

May be used to identify you

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Details of Reasonable Adjustment Required

Can we share this information with other NHS Providers?: *

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Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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