Complaints

Complaints Form

Please use this form to advise us of any concerns you may have.

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 Required

Yes

Additional Information

Access to Health Records

Armed Forces Friendly GP Practice

Carer Information

Hospital Contact List

Hospital Waiting Times

Infection Prevention Control

Patient Charter

Patient Participation Group (PPG)

Practice Vacancies

Privacy Notices & Policies

Private Referrals

Reasonable Adjustment Digital Flag

Self Referrals

Summary Care Record

You Said, We Did

Zero Tolerance Statement