Admin: Accessible Information

The Accessible Information Standard (AIS) is an NHS England information standard which must be implemented by all organisations that provide NHS or adult social care.

The AIS aims to ensure that people registered with our practice who have a disability, impairment or sensor loss receive information that they can access and understand. For example this could be in large print, braille or professional communication support if they need it such as British Sign Language interpreter.

We want to get better at communicating with people registered with our practice . We want to make sure you can read and understand the information we send you. If you find it hard to read our letters or if you need someone to support you at appointments, please let us know:

If you need information in braille, large print or easy read.
If you need a British Sign Language interpreter or advocate.
If we can support you to lipread or use a hearing aid or communication tool.

This information will be recorded on your medical record in a standardised way and highlighted to ensure we have information on your communication needs.

This information may be shared with other NHS and adult social care providers if required.

Please do not write any clinical queries on this form. Any clinical queries or request for appointments via this form will be discarded. To make an appointment either book online via the NHS app/Patient access or by calling reception 01926 331401. On receipt of your form we will update your clinical records. If you are NOT a registered patient then your form will be discarded. This service is only for patients registered at the surgery aged 16 and over; and for parents or legal guardians of children. Forms must be completed in the UK due to GDPR regulations.

Admin: Accessible Information

Full Name:

Date of Birth (DD/MM/YYYY):

Telephone Number:

Do you need information in:

Do you need anyone to come to appointments with you?

Can we support you to:

If applicable please explain what support would be helpful to you?

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 Clarendon Lodge Medical Practice • Clarendon Lodge, 16 Clarendon Street, Leamington Spa, Warwickshire, CV32 5SS.

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.