Accessibility needs

We want to make sure that you can access information and communicate with the surgery in a way that works for you. We will try to accommodate your needs as best we can.

Important

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Tell us what you need

Please complete this form so we can understand and support your accessibility and communication needs.

We need your name, date of birth and consent. Answer as many of the other questions as you like.

Your details

Date of birth (required)

For example, 15 3 1984

1. Communication preferences

For example, phone, email, text, letter or face to face.

Do you need information in a specific format?

For example, large print, braille, easy read, audio or a British Sign Language video.

2. Support needs

Do you need an interpreter?

For example, British Sign Language or a spoken language.

Do you need someone to support you at appointments?

For example, a carer, advocate or family member.

Do you need extra time during appointments?

3. Cognitive or learning support

Do you need information explained in a simpler way?
Do you need reminders for appointments in a specific format?

Privacy and consent

This form collects personal and medical information about you, and we use it to let the practice team contact you. When you send it, your answers go by email to the practice's NHS mailbox. This website doesn't keep a copy.

Please read our privacy policy to find out how we protect and manage your information.

If you'd rather fill in a paper copy, ask at reception.

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