Complaint Form

If you would like to make a complaint to the practice, please use this form.

Complaints

If you are human, leave this field blank.

Are you the complainant or complaining on the patient's behalf? *

I am the complainant

I am complaining on the patient's behalf

Patient Details

Patient Full Name: *

Contact Phone Number:

Patient Address: *

Usual Doctor:

Representative Details

Your Full Name: *

Your Address (if different than above):

I, the patient, authorise the practice to disclose confidential information about me to my representative in so far as is necessary to answer this complaint.

Details of Complaint

Your complaint: *

Patient Signature: *

Date:

Important -

What is the NHS App? The NHS App is owned and run by the NHS. It can be accessed by anyone aged 13 and over registered with an NHS GP surgery in England or Isle of Man. Once yo... Find out more

Important -

You can now register as a new patient via the NHS. Please use the following link to register: NHS New Patient Registration.

Important -

Upper Norwood Group Practice has set up a few on line Telephone appointments to book your own GP appointment. Please use your log ID if you have one or request the practice to r... Find out more

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Patient Details

Representative Details

Details of Complaint

Self Help