Barton Hills Medical Group - Complaints Form

Complaints
Our complaints manager is Fiona Greenbank, who will deal with any issues. Upon receiving your complaint, our Complaints Team will fully investigate the matter for you and take any appropriate action. You should also be contacted to inform you of the progress and outcome of your complaint, as well as to offer you any further advice or assistance if required.

We aim to acknowledge your complaint within 48 hours and do our utmost to resolve the issue to your satisfaction. However, if you are not completely satisfied with the outcome of your complaint, you have the right to contact the Health Service Ombudsman. You can do this by visiting www.ombudsman.org.uk/make-a-complaint, or by calling the PHSO Customer helpline on 03450154033.
Name

First NameLast Name
Date of birth

DayMonthYear
Date
Email
example@example.com
Telephone Number
Address

Street Address

Street Address Line 2

CityCounty

Post Code
Are you complaining on someone else's behalf?
What is your relationship to the patient
Is the patient aware of the complaint?
Has the patient given their consent to make this complaint
Concerned Patient Name

First NameLast Name
Concerned Patients Date of birth

MonthDayYear
Date
Concerned Patient Email
example@example.com
Concerned Patients Telephone Number
Concerned Patients Address

Street Address

Street Address Line 2

CityCounty

Post Code
What date did the incident occur?

MonthDayYear
Date
Please give an outline of your complaint.
Should be Empty: