Subject (if sending by email): Reasonable adjustments request

Dear [name of the person or service you are writing to],

I would like to ask you to make some adjustments to support me to use your service. These will help me to take part in the assessment and get the most from it.

Here are some adjustments that I think would help me:

Before the assessment:
[delete/edit the adjustment listed below as appropriate] 

• appointments to be arranged by email rather than phone
• to be given an agenda before the assessment
• information about the people that will be carrying out the assessment, including pictures of the staff
• visuals of the waiting room and assessment room>
• an uncluttered space / dimly lit space to wait in
• to be able to wait in my car
• Would anything else help? (add details here)

During the assessment:
[delete/edit the adjustment listed below as appropriate] 

• to bring someone I trust to the assessment 
• to take place in a quiet room
• to take place in a dimly lit room
• to bring a sensory aid (eg cushion, blanket, fiddle toy)
• a video/ virtual assessment
• for questions to be written down
• to be given visual supports
• to draw/ doodle
• to have short breaks 
• Would anything else help? (add details here)

After the assessment:
[delete/edit the adjustment listed below as appropriate]

• to receive follow up information and my report by email
• to receive follow up information and my report by letter
• to receive a phone call to explain my report.

I would be happy to discuss this request [insert preference, for example ‘via email’] in more detail, but I would like a written response within 14 days.

Yours sincerely,

[Your name and preferred contact details]