Hearing loss support needs

Use this form to tell the practice if you are deaf or have hearing loss, and what support you may need when attending appointments.

This information helps us make reasonable adjustments so we can communicate with you in the best way possible.

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

Start now

You can also phone us on 01953 881247.