West Moors Village Surgery Complaint Form

To pursue a complaint please complete this online form online form and the practice manager will deal with your concerns appropriately.

Your Details

Name *

Date of Birth (DD/MM/YYYY) *

Phone Number

Email Address *

Complaint

Your Complaint *

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. *

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

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Page last reviewed: 16 June 2023
Page created: 23 February 2023

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West Moors Village Surgery Complaint Form

West Moors Village Surgery Complaint Form

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