Patient complaint and compliment form

If your complaint relates to a breach of information or privacy, please use our Privacy Complaint Online Form instead.

If you are providing feedback on someone else’s behalf, have you received consent to do so?

Please note we are required to confirm consent directly with the patient and contact will be made once the feedback is received.

If you are providing the feedback on behalf of someone else, provide the patient’s details below:

Patient - First name

Patient - Last name

Patient - Phone number

Patient - Email address

Patient - Date of birth (so we can look at your file)

Patient - Origin *