Complaints and compliments | Tudor Lodge Surgery

Name * We understand that you may wish to submit your feedback anonymously - by doing so it will be impossible for us to investigate any issues that you may raise thoroughly, so please leave your name and contact details so that we can investigate your issues and give you a response.

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What type of feedback would you like to leave? *

Complaint Compliment Please be aware that we will contact the patient involved about the complaint to verify their consent.

Are you the patient involved in this complaint or are you making a complaint on behalf of someone else?

I am the patient I am not the patient

Do you have the consent of the patient involved to make this complaint on their behalf? *

I do have the consent of the patient involved to make this complaint I do not have the consent of the patient involved to make this complaint

Who would you like to leave this feedback about? This helps us to let the people involved know about your feedback.

Do you know the name(s) of the staff involved? This helps us to investigate your issue fully

Date

Time

What is the issue? *

What would you like to happen to resolve this issue?

Your Feedback *

How would you rate your experience?

If you do not have the consent of the patient involved to make this complaint, then please gain consent before making this complaint or we cannot investigate the issues raised

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Complaints & Compliments