Feedback Form - Waitaha Primary Health

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Feedback

Complaints and positive comments provide us with an opportunity to continually assess and improve our service.

Please use this form to send us a patient complaint or send us your positive comments/experiences.

Complaints process:

Your complaint will be acknowledged to you within five working days of receipt.
We will endeavor to investigate your complaint within 10 working days from the date of acknowledgment. You will be informed if this will take longer
Where extensive investigations are required, you will be kept informed in writing at monthly or at agreed intervals until the matter is resolved.

Feedback Form

Person making the complaint*
Preferred Contact Number (include area code)*
Address*
Street Address City Region ZIP / Postal Code Country
Email
Complaint on behalf of another
- Yes
- No
Date of Event leading to the Complaint*
DD slash MM slash YYYY
General Practice Name*
Permission for PHO to contact the general practice
- Yes
- No
Details of Complaint*
Suggested Resolution/Action*
* This information is required to submit this form. Thank you.
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