Communication Needs

We want to ensure we are good at communicating with our patients.  We want to make sure you can read and understand the information we send to you.  If you find it hard to read our letters or if you ened someone to support you at appointments, please let us know by completing this form.

Last Updated: 06/03/2024

Your Details:




Difficulty communicating due to Sensory Loss






Do you have difficulty making yourself understood or understanding others?











Tell us about the person who helps you with communicating






Do you have any other communication needs that we have not asked about?


Patient Declaration

I confirm that the information I have given is correct and where indicated I have given persmission for the Practice to make arrangements on my behalf, for example arranging an interpreter or contacting my carer.

I understand the information I have given on this form will be recorded in my medical records and shared with other health professionals when it is in my best interest to do so.



Important information for you

We will record the information you have given us in your medical records so that all our staff are aware of how they can help you.

If we refer you to another organisation, for example the Hospital, we will tell them about your communication needs to make communicating with them easier for you.

If your needs change at any time or you feel your needs are not being met, please let us know.

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