Complaints Form - East Park Medical Centre

Should you wish to make a complaint about the practice please complete our complaints form and one of our management team will be in touch.

Complaints

Name

Prefix First Last

Date of Birth

NHS number if known:

Is the complaint about yourself or someone else: Optional

If the complaint is about a third party please be aware that on receipt the practice will need to gain consent from the named patient. Optional

Where did your concern happen? Optional

Who did it involve? Optional

What are your main questions? Optional

What outcome are you hoping for? Optional

How is best to contact you? Optional