Complaints Form

We make every effort to give the best service possible to everyone who attends our practice. However, we are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible. To pursue a complaint please complete this form and the practice manager will deal with your concerns appropriately.

Once you have submitted our complaints form, and the practice has investigated the incidence, you will be informed of the findings via email. If you have any questions please do not hesitate to contact our Practice Manager.

If you are complaining on behalf of someone else , we require their authorisation to do so. Please contact the Practice, so we can complete the necessary documentation to allow us to proceed.

Complaints

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Preferred method of contact

Phone

Please describe the issues that have led to this complaint. This will help us understand the key problems that you have experienced. *

Please can you tell us why you think this may have happened? For example, as a result of conflicting messages, a personality conflict, a problem with communication within the surgery, etc. *

Are you looking for a specific outcome from this complaint? For example, common outcomes that help us improve our service include training, improved communication or looking at ways to work differently. *

We would like to review this complaint as part of our complaints procedure. Part of this is to discuss your case with the team to make sure we share any learning. Are you happy for this to happen?

Yes

Your confirmation *

I understand the practice complaints procedure and timelines to be followed.

Privacy Policy

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our Privacy Policy to discover how we protect and manage your submitted data.

Your consent *

I consent to the Practice collecting and storing my data from this form.

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Complaints Form

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