Your Complaint - New Road Surgery Bromsgrove

Complaint Form

Please complete this form to raise your complaint with the practice. Once completed we will contact you to acknowledge receipt of your complaint and will endeavour to respond within 14 days.

Your Details

Name *

Date of Birth *

Telephone 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. *

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Page last reviewed: 19 March 2024
Page created: 19 March 2024

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Complaint Form

Complaint Form

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