Feedback Form

Please complete this form if you wish to leave feedback. Please refer to our Complaints procedure for further information.

Complaint Form
Complainant
Complaining on behalf of someone else
We keep strictly to the rules of medical confidentiality. If you are not the patient, but are complaining on their behalf, you must have their permission to do so. A Letter of Authority signed by the person concerned will be required, unless they are incapable (because of illness or infirmity) of providing this. A Third Party Consent Form must then be completed; this can be requested from Reception. Once this Form is completed we can then proceed with the complaint.
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Please use format day/month/year e.g. 12/05/1979

Privacy Policy

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.