Complaints Form – The Spa Surgery

telephone if the

Your Details

Name

First

Last

DOB

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Summary of Complaint

Please describe the events leading to your complaint to help us understand your experience

Please tell us (in your own words) why you think these events occurred?

Have you experienced this issue before?

…either at this surgery or at another healthcare provider. Please provide details if it was previously resolved

Can you help us understand what you think should have happened?

Please tell us what you want to achieve from this complaint?

Common outcomes from complaints include improving our service through training, saying sorry when we have made a mistake, addressing a communication problem or exploring the issues with you in more detail.

We would like to review this information as part of our ongoing commitment to improving our services. We would hope to reach a positive outcome for you and the practice and ensure that our systems are as effective as we can make them.

Would you like us to review this feedback going forward as part of our learning?

Yes
No

Would you like us to arrange a telephone call with you and the Practice manager?

Yes
No