Tell us whether you accept cookies

We've put some small files called cookies on your device to make our site work. We would also like to use analytical cookies to understand how our site is used and improve user experience. Analytical cookies send information to Google Analytics.

Let us know your preference. We will use a cookie to save your choice. Before you make your choice you can read more about our cookie policy.

Bampton Medical Practice NHS GP surgery in Oxfordshire

Reasonable adjustments

Do you need us to communicate with you in a particular way? *

Yes

I don’t know

For example: interpreter, BSL, Makaton

Please specify: *

Do you need information in easy read or large print? *

Yes

I don’t know

Please specify the font and type: *

Do you want us to communicate with your family, friend or carers who give you support? *

Yes

I don’t know

Name of person who supports you: *

Phone number of person who supports you: *

What is their relationship to you? *

Do you need a longer appointment? *

Yes

I don’t know

Please specify: *

Do you need an appointment at a particular time based on things such as carer availability?

Yes

I don’t know

Please give examples of suitable times:

Do you have any other reasonable adjustments that would help you to attend appointments? *

Yes

I don’t know

Please specify: *

Confirmation *

I have read and understand about having my needs written on my health record on the computer.

Would you like a reasonable adjustment flag on your record? *

Yes – I would like a reasonable adjustment flag

No – I do not want a reasonable adjustment flag

Would you like your adjustments to be shared with other teams in the NHS or social care? *

Yes – I would like my adjustments to be shared

No – I do not want my adjustments to be shared

Signature: *

Date:

If you are human, leave this field blank.

Landells
Bampton
Oxfordshire
OX18 2LJ

Get directions

01993 850257

Feedback and complaints

Wellbeing

You and your general practice

Accessibility statement

Website policies