Complaints Form

If you have any difficulties filling out the form linked to from this page, or have any questions about the complaints process then email shropcom.customerservices@nhs.net or telephone 01743 277 616.

Complaints Form

Essential information All items in this form need to be completed in order for the information to be logged. If you have any difficulties filling out this form or any questions about the complaints process then email shropcom.customerservices@nhs.net or telephone 01743 277 616.
Date of complaint (format: dd/mm/yyyy) *
Name of person raising the complaint *
Address of person raising the complaint *
Date of birth
Ethnicity
Daytime contact telephone number (9am to 5pm)
Mobile telephone number
Email address
Email address
NHS number (if known)
Service/ward complaint relates to
Name of staff member(s) identified in complaint
Details of the complaint
Details of any action taken
What do you think we should do to put things right?
How would you like us to contact or reply to you?	Letter Telephone call Meeting Other

Page last reviewed: 25 September 2023

Next review due: 25 September 2024

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Complaints Form

Essential information

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