COVID Spring Booster update

We will not be offering Spring booster vaccines at our Practice. More info here about how to book if you are eligible

Goring & Woodcote Medical Practice > Forms > Complaints Form

Complaints Form

Please read our Complaints Procedure before completing this form

Complaints

First Name *

Last Name *

Email *

Date of birth *

Please use format day/month/year e.g. 12/05/1979

Phone Number *

Summary of Feedback/Complaint *

Please describe in one or two sentences the issues that have led to this complaint. This will help us understand the key problems you have experienced.

Have you experienced this issue before? *

This may include at this surgery or at a previous healthcare provider. Please provide details if it was previously resolved.

Please can you describe how this issue may have occurred *

For example, problems can arise due to conflicting messages, personality conflicts, or where we were unable to meet your expectations. Understanding this aspect helps us to explore the full circumstances surrounding the issue.

Please describe any specific outcomes from this feedback? *

Understanding our patients’ needs is important to us so that we can explore and address issues fully. Common outcomes that patients value include improving our service through training, saying sorry when we have made a mistake, addressing a communication issue or exploring the issues with you in more detail.

We would like to review this feedback as part of our ongoing commitment to improving our services where possible and reaching a positive outcome for both you and the practice, ensuring 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

Your confirmation *

I understand the practice complaints procedure and timelines to be followed.

Signature

Clear

Print Name

If you are completing this for somebody else, please write your name below:

Privacy Policy

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.

Your consent *

I consent to the Practice collecting and storing my data from this form.

Captcha

COVID Spring Booster update

Complaints Form

Privacy Policy

Health A-Z

Live Well

Medicines Guide

Care & Support

Goring Surgery

Woodcote Surgery