Complaints

Complaints Form

Please use this form to advise us of any concerns you may have. Please note, this form is for submitting complaints regarding Priory Medical Centre in Warwick and not Priory Medical Group in York or Priory Gardens Medical Centre in Dunstable. If you are a patient at either of these practices, please contact that practice directly.

Name Required

Prefix First Last

Date of Birth Required

How would you like us to contact you (Patient)? Required

Phone

Phone (Patient) Required

Email (Patient) Required

Please advise us of your concerns Required

Date of when the issue occurred Required

Would you like to nominate a third party to manage your complaint? Required

Yes

Third Party Details

Name Required

Prefix First Last

Date of Birth Required

How would you like us to contact you (Proxy)? Required

Phone

Phone (Proxy) Required

Email (Proxy) Required

Comments Optional

Date of when the issue occurred Required

Outcome

Outcome: Please advise your expected outcome for this complaint Required

Consent

I can confirm I am a registered patient at Priory Medical Centre in Warwick - this form is not for Priory Medical Group in York or Priory Gardens Medical Centre in Dunstable. Required

Yes