Complaints Form

Please note that we can only investigate issues with patient consent. If you are completing this form on behalf of an adult, we require their consent to proceed.

Your Details

Your Name

Date of Birth

Address

Summary of Complaint

Please describe the events leading to your complaint to help us understand your experience

Please tell us (in your own words) why you think these events occurred?

Can you help us understand what you think should have happened?

Please tell us what you want to achieve from this complaint?

Common outcomes from complaints include improving our service through training, saying sorry when we have made a mistake, addressing a communication problem or exploring the issues with you in more detail.

Next steps and what you can expect from us

We would like to review this information as part of our ongoing commitment to improving our services. We would hope to reach a positive outcome for you and the practice and ensure that our systems are as effective as we can make them.

Would you like us to review this feedback going forward as part of our learning?

Yes

Would you like us to arrange a face-to-face meeting with you and a GP Practice manager?

Yes