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1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Patient Information. Fill in your name, local address, telephone number, date of birth, and the best day/time to be reached.
3. Next, provide Complainant Information. Enter the name of the person initiating the complaint, their address, telephone number, and relationship to the patient.
4. Indicate the Nature of Complaint by checking the relevant boxes such as Appointment/Access, Medical Care, Billing, etc.
5. In the Problem section, specify any issues encountered with staff or services. Include details like time & date of incident and names of staff involved if known.
6. Describe your dissatisfaction in your own words and state what you would like to see happen as a result of your complaint.
7. Finally, sign and date the form to confirm your understanding regarding confidentiality and submission process.

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