Village Health Group - Compliments and Feedback Form

This form is designed for compliments and positive feedback. If you wish to make a complaint, please use the complaint form or refer to our complaints procedure.

Last Updated: 27/08/2020

Your Details

Please select your registered branch from the options below: *

East Leake

Keyworth

Ruddington (Church House)

Sutton Bonington

Name *

Date of Birth *

Phone Number

Email Address *

Compliments and Positive Feedback

This form is designed for compliments and positive feedback. If you wish to make a complaint, please use the complaint form or refer to our complaints procedure.

Your Positive Feedback *

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.

Village Health Group - Compliments and Feedback Form

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