Complaint Form

Complaints

We hope that most problems can be sorted out easily and quickly, often at the time they arise and with the person concerned.  If problems cannot be sorted out in this way and patients wish to make a complaint, we would like them to let us know, as soon as possible.

Our practice compliments, suggestions and complaints procedure can be downloaded from here

To make a formal complaint, please contact us using the form below

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Complainant details

Name *

First

Last

Phone number *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Patient details

Only complete this section of the patient details are different from the complainant’s details.

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Problem reported

of Identify time

Date and time *

Date

Time

Place it happened *

Identify members of the practice

How was the situation left? *

What would you like the outcome of the situation to be? *

By completing this section, you will help us understand exactly what you are hoping to achieve by making this complaint. If you could achieve 3 things by this complaint, what would they be?

Full description of events *

The facts and events that contributed to you making a complaint.

Submit