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Reasonable Adjustments Form

Reasonable adjustments are small changes that can help people with a disability or health condition with a big and long term effect on their lives to be treated equally. 

The law says that reasonable adjustments should be put in place. These are simple changes made by healthcare staff. It is your right to ask for reasonable adjustments.

This could be the way that they treat you or the things that you need when you are in hospital. Every person is different and will need different things but there are some which are more common.

Examples of reasonable adjustments you could ask for include:

  • Doctors who speak clearly and use simple words
  • More time with the doctor, for example, a double appointment
  • Having support workers or family members with you

If you would like us and other NHS services to offer you reasonable adjustments, please fill in this form and return it to Marine Medical Group.

Reasonable Adjustments Form
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Please use format day/month/year e.g. 12/05/1979
Can we share this information with other NHS Providers?

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.