AMC Complaints Form 2022

Please ensure you have read the complaints process before completing this form

Last Updated: 10/08/2022

Your Details

Name *

Date of Birth *

Phone Number

Email Address

Complaint

Your Complaint - please provide as much information as possible, along with any relevant dates and what outcome you wish to see from your complaint *

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.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the Abington Medical Centre website

AMC Complaints Form 2022

Further Information