Chaperone

At our practice, we are committed to ensuring that all patients feel safe, respected, and comfortable during their consultations and examinations. You have the right to request a chaperone for any appointment, particularly if an examination is of an intimate or sensitive nature.

A chaperone is a trained member of staff who can be present during your consultation or examination to provide reassurance and support.

When might you want a chaperone?

You may wish to request a chaperone if:

  • Your examination is intimate (e.g. breast, genital, or rectal examination)

  • You feel anxious, vulnerable, or would simply prefer another person present

  • You would feel more comfortable with a member of staff of a particular gender present

Your choices

  • You can request a chaperone for any appointment

  • You can decline a chaperone if one is offered

  • You may request a chaperone of a specific gender, where possible

  • You may also bring a friend or family member, although this does not replace a trained chaperone

Request a Chaperone Form

Please complete this form to request a chaperone ahead of your appointment. Once submitted, we will have a chaperone arrange for your appointment.

About You (The Patient)

Name  Required
Date of Birth  Required
Address  Required

Chaperone Request

Date of Appointment  Required
Would you like to request a chaperone?  Required
Do you have a preference for the chaperone's gender?  Required
Privacy Protection  Required

Additional Information

Carers

Chaperoning

GDPR, Data Processing and Subject Access Request (SAR)

Infection Control

Long Term Conditions

Summary Care Records

Zero Tolerance Policy

Non-NHS Services

Patient Participation Group

Responsibilities

Talking Saves Lives

Winter Health

Community and Locality Services

Complaints Policy