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

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: 1 October 2024

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Complaints Form

Essential information

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