We hope you will not have the need to make a complaint, we strive to deliver a level of medical and non-medical care that will not give rise to a complaint. However, if you feel that you have a genuine complaint regarding the level of care or service received, we invite you to follow our complaints procedure. If you would like to email your concerns directly to the Surgery communication department, please email: patientservices.scmg@dorsetgp.nhs.uk

Please click here to view our complaints procedure.

Please see below the complaints form

Full Name: *

Date of Birth: *

Please use this date format: DD/MM/YYYY.

Phone Number:

Email Address: *

Complaint Details

Name of Surgery/Service:

Patient Name (if different to complainant):

Patient Date of Birth:

Please use this date format: DD/MM/YYYY.

Relationship to complainant:

Date of incident:

Please use this date format: DD/MM/YYYY.

Time of incident:

Staff members involved (if known):

Brief description of incident:

Expected outcome: for completion by complainant

Explanations regarding:

Please write in note form the key issues you would like an explanation for.

Apology for:

Please write in note form the issues you would like an apology for.

Other outcome:

Please write here any other outcome that you would like to see as a result of our investigation of your complaint.

Complainant's signature:

By ticking this box I am signing as the complainant