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Online Complaint Form
Vasu Karri
2023-01-16T20:21:24+00:00
Online Complaint Form
Please complete the form below to submit your complaint. The form is designed to capture your complaint as quickly and as easily as possible, and will be passed directly to our complaints team.
Once received, we will take all necessary steps to investigate your issue and resolve your complaint.
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Postcode
Email
(Required)
Phone
Up-to-date?
(Required)
Tick to confirm you have provided your up-to-date contact information
Please Note:
Our calls may appear as 'private', 'unknown' or 'withheld' on certain handsets. If you have provided a valid email address, please check your junk email folder as emails may fall into here instead of your inbox.
What does your complaint relate to?
(Required)
Clinic
Outcome of surgery
Surgeon
Anaesthesia
Nursing care
Medication
Other
Have you complained about this issue before?
(Required)
Yes
No
Tell us about your complaint (use clear and factual language, and use no more than 800 words)
1. A summary of your complaint, including key dates
(Required)
2. Your concerns in bullet points
Tell us what your ideal outcome would be
(Required)
Signature
(Required)
Date
(Required)
DD slash MM slash YYYY
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