Suggestion or Complaint

Please use this surgery for any suggestions of complaints you may have which may help us improve our service.
 

 

Please fill in all the boxes.
 

Use the TAB button on your keyboard, or use your mouse to the next box. Please do NOT hit Enter on your keyboard. If you do this, you will be told you have not filled in the form correctly and asked to do it again.
  All replies will be sent to the e-mail address you supply or the registered address on your records.
  We cannot give a timeframe for a response due to the nature of the queries we receive which may need investigation, but rest assured, your comments will be dealt with.
  A member of the admin team WILL see your e-mail. If you are not happy with this, please do not use this service.

Important
You must accept the Terms & Conditions of this service and tick the checkbox at the bottom of this form. You will not be able to use this form without accepting our Terms & Conditions of Service.

Please leave blank

Your Details

First Name*

Surname*

Are you a Patient?

Phone Number

E-mail Address

Your Comments


 Terms & Conditions

I accept the Terms & Conditions of Service*

 

 
 

Copyright © 2009 Dartmouth Medical Practice