Online complaint form

When providing details of your complaint it is helpful if you can include specific information if you know it, such as names of staff involved and where the incident happened.

If you are complaining on behalf of someone else, we will need their permission for you to act on their behalf. If the patient is a child or lacks capacity to provide consent we will need proof of ID from you. We will ask for this information when we acknowledge receipt of your complaint.

Patient details:

Title:*

First name:*

Last name:*

Postal address including postcode:*

Contact number:

Email address:

Date of birth:

NHS number (if known):

Your details (if you are not the patient):

Title:

First name:

Last name:

Postal address including postcode:

Contact number:

Email address:

What relationship are you to the patient?

Which site did the issue take place:*

Which ward did the issue take place:

Date the issue took place:*

Please summarise the issue that has led to you to make your complaint:*

Any additional information:

What would you like to happen as a result of your complaint? Please note that if we do not think that we can achieve what you want, we will let you know.

Other:

What is your preferred method of communication?

Other:

The information I have provided is accurate to the best of my knowledge.*

* required fields

Important alert: Phone line disruption

We want to let you know that our hospital phone lines are currently experiencing technical difficulties and are temporarily unavailable. We understand this may cause inconvenience, and we sincerely apologise.

If you wish to cancel your appointment, you can use our online cancellation form.

Our team is working urgently to resolve the issue and restore phone service as soon as possible.

Thank you for your patience and understanding.

Industrial action: 14 - 19 November

The British Medical Association has announced that resident doctors in England will stage industrial action from 7am on 14 November to 7am on 19 November.

During this time, some of our services may be affected. We will contact you directly if your appointment needs to be changed. Otherwise, please attend your appointment as planned.