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

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

Start Date *

Start Time *

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End Date *

End Time *

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Service Area

Please let us know what area of our service you wish to complain about * Appointments Prescriptions Medical Care Communications Staff Premises Other

What happened?

In your own words, please tell us what happened *

How should we improve things?

Please let us know what outcome you are expecting *

Would you like us to respond to your complaint?

If you wish to post anonymously, please select No. If you wish to have a response, please select Yes, and then provide your contact details. *

Yes

No

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 *

Name *

Email

(Optional)

Home Address *

Date of Birth *

How would you like us to contact you? * Email Letter Telephone

If you are human, leave this field blank.