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Watership Down Health NHS GP Surgeries in Hampshire

Reasonable adjustment request

Reasonable Adjustment Request

Communication and access needs: *

I need information in large print

I need information in easy-read format

I use British Sign Language (BSL)

I need help with reading or understanding letters

I need a longer appointment time

I need a quiet space while waiting

I need wheelchair-accessible facilities

I need support with hearing

I need support with vision

I prefer to be seen with a carer or advocate

Other

Please select any adjustments that would help you when accessing care.

Please specify: *

Do you give us permission to add a Reasonable Adjustment Flag to your NHS record? *

Yes, I agree

No, I do not want this recorded

Please let us know the reason that you need the adjustment: *

Signature: *

Date

All information will be kept confidential and only shared with relevant NHS staff to support your care.

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Kingsclere Health Centre
North Street
Kingsclere
Newbury
RG20 5QX

Get directions

0333 034 1033

Oakley Surgery
Sainfoin Lane
Oakley
Hampshire
RG23 7HZ

Get directions

0333 034 1033

Overton Surgery
Station Road
Overton
Hampshire
RG25 3DU

Register with the surgery

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