Complaints - GARDEN STREET SURGERY/BELLAGHY MEDICAL CENTRE

Complaint Form

Your Details

Name *

Date of Birth *

Phone Number

Email Address *

Complaint

Your Complaint *

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Page last reviewed: 21 May 2021
Page created: 30 December 2024

Cookies on the GARDEN STREET SURGERY/BELLAGHY MEDICAL CENTRE website

Complaint Form

Complaint Form

Further Information