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Reasonable Adjustments

In accordance with NHS guidelines and the Equality Act 2010, we offer reasonable adjustments to ensure that patients with disabilities or impairments can access the care they need without unnecessary barriers.

What are Reasonable Adjustments?

Reasonable adjustments are changes or modifications made to our services, procedures, or environment to help individuals with disabilities or impairments access our healthcare services more easily.

These adjustments are tailored to meet the specific needs of each patient and can include:

Providing information in alternative formats (e.g., large print, Braille, audio)
Support with communication (e.g. interpreter)
Offering longer appointment times
Ensuring physical access to our facilities
Providing assistive devices or support for communication
Allowing a support person to accompany you during visits

Our goal is to ensure that all patients receive high-quality care in a manner that respects their individual needs and promotes their health and well-being.

How to Request a Reasonable Adjustment?

If you require any reasonable adjustments for your healthcare access, please let us know.

You can do this by:

Speaking with a member of our staff directly
Calling our practice
Filling out the questionnaire below and submitting it to us online or via email:
Adding information on the new patient registration form when registering with our practice.

Your input helps us understand your needs and arrange the necessary support to improve your healthcare experience.

Please select the practice location most relevant to this Online Form submission:

Reasonable Adjustments

First Name

Surname

Date of Birth:

NHS Number

Address

Telephone

Mobile Telephone

Reasonable Adjustment Digital Flag

Do you give consent to upload data to the Reasonable Adjustment Digital Flag?

Communication Support

Do you use any of the following communication methods or communication aids?

Non verbal communication

Alternative communication skill

Mobile apps to support communication

Communication device

Cued speech transliterator

Deafblind intervener

Deafblind Manual Alphabet

Electronic writing aid

Electronic note taker

Eye pointing

Gestures

Hearing loop

High technology communication device

Lipspeaker

Low technology communication device

Manual note taker

Objects used to communicate

Personal audio recording device to record information

Personal Communication Passport

Pointing

Sign language

Speech to text reporter

Symbols and pictures

Switches used for communication

Tadoma method

Textphone

Voice amplifier used to support communication

Voice output communication aid Written communication

Other

If you answered Other above, please give details below.

Communication Professional

Do you require any of the following communication professionals?

Hands-on signing interpreter needed

Interpreter needed

British Sign Language Interpreter needed

Makaton Sign Language Interpreter needed

Deafblind block alphabet interpreter required

Deafblind communicator guide required

Deafblind haptic communication interpreter required

Deafblind manual alphabet interpreter required

Lipspeaker required

Manual note taker required

Sighted guide required

Speech to text reporter required

Sign Supported English interpreter needed

Visual frame sign language interpreter needed

Needs an advocate

Specific Contact Method

Do you require any of the following specific contact methods?

Audible alert required

Contact by email

Contact by letter

Contact by SMS

Contact by telephone

Contact by text relay

Contact via carer

Contact via telephone interpreting line

Tactile alert required

Visual alert required

Information Format

Do you require any of the folIowing information formats?

Healthcare info recording on personal audio device required

Written information in at least 20 point sans serif font

Written information in at least 24 point sans serif font

Written information in at least 28 point sans serif font

Deafblind communicator guide required

Information by email

Information in uncontracted (Grade 1) Braille

Information in contracted (Grade 2) Braille

Information in Easyread

Information in electronic audio format

Information in electronic downloadable format

Information in Makaton

Information in Moon alphabet

Information on audio cassette tape

Information on compact disc

Information on digital versatile disc

Information on USB mass storage device

Information verbally

Lipspeaker required

Loud verbal communication required

Manual note taker required

Third party required to read out written information

Additional Communication Needs & Support

Do you have or require any of the following additional communication needs or support?

Has difficulty analysing information

Has difficulty processing information accurately

Has difficulty processing information at normal speed

Emergency contact details of specialist support team

Expresses pain atypically

Has My Healthcare Passport

Needs assistance with communication

Requires appointment reminders

Requires approach to care to be discussed with carer

Requires carer to be present at encounters

Uses apps on mobile device to support communication

Uses switches for communication

Uses Tadoma method for communication

Interpreter

Do you require an interpreter?

If you answered Yes, please give details of what language you require an interpreter for.

Additional Other Support

Do you require any of the following additional support?

Dependence on seeing eye dog

Emergency contact details of specialist support team

Has appointed person with personal welfare LPA (MCA 2005)

Has appointed relevant persons representative (Mental Capacity Act 2005)

Needs assistance with medication regimen adherence

Requires additional healthcare personnel to be present at encounter

Requires approach to care to be discussed with carer

Requires constant supervision

Requires enhanced discharge planning

Unsafe to be left alone

Uses emotional support animal

Uses guide dog for the blind

Individual Care Requirements

Do you have any of the following individual care requirements?

Anxiety related to clinical environment

Dependence on seeing eye dog

Has anticipatory care plan

Needle phobia

Needs assistance with medication regimen adherence

Preference for female healthcare professional

Preference for male healthcare professional

Requires distraction technique whilst undergoing care procedure

Requires extended appointment

Requires familiarisation with care environment

Requires familiarisation with care procedure

Requires first appointment in appointment schedule

Requires home visit appointments

Requires last appointment in appointment schedule

Requires minimal waiting time between arrival and being seen in care environment

Requires priority appointment

Requires single room during inpatient care

Unable to manage medication

Uses dispensed monitored dosage system

Adjustments to Environment of Care

Do you require any of the following adjustments to the environment of your provided care?

Anxiety related to clinical environment

Eyes sensitive to light

Noise intolerance

Light hurts eyes

Requires familiarisation with care environment

Requires low light environment

Requires low noise environment

Requires single room during inpatient care

Requires wheelchair access

Uses emotional support animal

Uses guide dog for the blind

Adjustments to Support Additional Needs

Do you require any of the following adjustments to support additional needs?

Assessment of eating and drinking behaviour

Constipation care

Dysphagia therapy regime

Screening for risk of falls

Seizure management

Self-harm behaviour management indicated

Thyroid function test

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Riverside Surgery • Le Molay-Littry Way, Bovey Tracey, Devon, TQ13 9QP.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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