Complaint Form Important information:Please use this form to raise a complaint or concern. Do not use this form for medical queries, medical emergencies, or appointment requests.Are you completing this form on behalf of someone else? No, I am the patient Yes, on behalf of someone else Patient's Full NamePatient's Date of BirthPatient's Telephone NumberPatient's AddressYour email address (the person completing the form) Your Phone Number (the person completing the form)Please give the full details of the complaint below, including dates, times, locations and names of any organisation staff (if known).Please NotePlease refer to our Complaints Procedure for information on what to expect during the process, available advocacy services for support, and the steps to take if you are dissatisfied with the outcome.
