Title e.g. Mr, Mrs, Miss, Dr etc.
Date of birth
Daytime contact telephone number
Mobile telephone number
How would you prefer us to contact you?*
By phoneBy emailBy post
Your relationship to the patient
Are you contacting us about a concern or a complaint?
Please give the name of the organisation, service or person your concern or complaint relates to
In the box below, please explain why you want to complain and give as much detail as possible. The following questions may help you; what happened, who was involved, what was said, where and when did it take place? (please give dates and times if possible), why do you think the service failed?
What outcome would you like in response to help resolve your concern or complaint?
An apologyAn explanation ImprovementsChanges madeOther (please specify below)
Click the button below to submit your complaint. This form will be sent to the Patient Support Line at Bradford Districts and Bradford City Clinical Commissioning Groups (if you have given your consent).
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