Complaint Form - The Springs Medical Partnership

Springs Complaint Form

Your complaint will be investigated by The Management Team and a response will be sent to you within 10 working days.

Your Details

NOTE:

If you are not the patient, has consent been gained from the patient giving permission for us to discuss their medical records with you? A Third-Party Consent Form will need to be completed which is available on our website.

Name *

Date of Birth *

Phone Number *

Email Address *

Complaint

Your Complaint *

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: 02 July 2024
Page created: 01 August 2024

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Springs Complaint Form

Springs Complaint Form

NOTE:

If you are not the patient, has consent been gained from the patient giving permission for us to discuss their medical records with you? A Third-Party Consent Form will need to be completed which is available on our website.

Further Information