Patient Feedback

Feedback

Please use this form to send in any feedback you have for the surgery, positive or negative! We are always happy to hear your opinions on how we could improve things in the surgery or things that you think work particularly well.

Name

First Last

Phone Optional

Date of Birth Optional

CommentsUse the box below to write your feedback about the surgery and please include as much information as possible.

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.