Your Complaint - Queensway Surgery

Complaint Form

Your Details

Name *

Address

Date of Birth *

Phone Number

Email Address *

Complaint

Complaint details - Please give full details of the complaint below including dates, times, locations, and names of any organisation staff (if known). *

EXPECTED OUTCOME *

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. *

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Page last reviewed: 03 April 2023
Page created: 29 September 2022

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Complaint Form

Complaint Form

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