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Reasonable adjustment questionnaire

Use this service to tell us if you need any reasonable adjustments to help you access our services.

You can use this service if you:

  • are registered at the surgery

Before you start

We’ll ask you for:

  • your first and last name, date of birth, sex, postcode, email and phone number
  • if applicable, the details of the person you are completing the form on behalf of
  • what support or adjustments would help you
  • your consent for us to record and share this information to support your care
Start now

You can also phone us on 01384 987740.

Page published: 23 February 2026
Last updated: 11 March 2026