Feedback and Complaint Form - Woodlands Surgery

Complaint Form

Patient Details

Name *

Telephone Number *

Address *

Date Of Birth *

Email Address *

Complaint Details

Please give full details of the complaint below including dates, times, locations and names of any organisation staff (if known). Continue on a separate page if required. *

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.

If this form is not related to feedback or complaints I consent to this form being discarded, *

Yes I understand.

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

Page last reviewed: 14 May 2026
Page created: 13 August 2020

Cookies on the Woodlands Surgery website

Complaint Form

Complaint Form

Further Information