I wish to make a complaint

Complaint Form

We are sorry that you wish to make a complaint, and please rest assured that all complaints are treated in the strictest confidence. Making a complaint will not affect your treatment or care, and your complaint will not be noted on your medical record. We aim to deal with comments and complaints as easily and as quickly as possible, and we are committed to learning and improving through all of our feedback channels.

Do you want to leave Feedback? If you simply wish to feedback rather than make a formal complaint, you should complete our Feedback Form

Complaint

Select your practice *

When did the issue you wish to make a complaint about happen?

Start date *

End date *

Service Area

Please let us know what you wish to complain about *

Please specify

What happened?

Please tell us what happened in as much detail as possible including times and people involved *

How should we improve things?

Please let us know what outcome you are expecting *

Would you like us to respond to your complaint?

Select YES if you wish to have a response to your complaint, and then provide your contact details below . If you wish to post anonymously, please select No. We will be unable to respond to your complaint if you select No. *

Yes

Contact

Your contact details (if you wish to have a response)
You must fill in all of the fields below if you wish to have a response, we will be unable to respond without all of the information below.

Title

Please specify

Full name *

Date of birth *

Email address

Home address *

Telephone Number *

How would you like us to contact you? *

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