Form: Complaints+form

Complaint details

Note: Questions marked by * are mandatory

Complainant/concern details

Name:

Address:

Telephone number:

Date of birth:

Patient/service user details

*This is a mandatory field. Name:

*This is a mandatory field. Address:

*This is a mandatory field. Telephone no:

*This is a mandatory field. Date of birth:

Your email Address

Relationship to patient/service user:

*This is a mandatory field. Has patient/service user given consent for you to act on their behalf? (We will contact the patient/service user involved to get their consent for you to act on their behalf)

What is your desired outcome?

*This is a mandatory field. Service/s involved:

*This is a mandatory field. Details of Complaint:

The Trust’s Complaints Review Committee monitors how complaints have been managed and sometimes reviews the outcome of individual complaints. This enables us to ensure that complaints have been properly dealt with, and also enables us to learn the lessons from complaints. If the complainant would prefer that their complaint/concern is not considered by this forum please tick here:

Tick here

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