Online Complaint Form Your Name First Last Date of birth Day Month Year Your Email address Your Contact NumberReason for complaintAre you making this complaint on behalf of someone else? Yes No Patient's Name First Last Patient's Date of birth Day Month Year Your relationship to patient If you are complaining on behalf of a patient or your complaint or enquiry involves the medical care of a patient then the consent of the patient will be required. I fully consent to my Doctor releasing information to, and discussing my care and medical records with the person named above in relation to this complaint only, and I wish this person to complain on my behalf. Your complaint should be acknowledged by the GP practice either verbally or in writing within 3 working days. As part of this acknowledgment, you should be informed about the length of time it will take to investigate your complaint. We aim to reply within 40 working days and up to 60 working days for more complex cases. During the investigation you should be kept up to date with the progress of your complaint.