Enquiry form

Your enquiry doesn't commit you to the complaint process yet, we will contact you when it suits you to gather further information. All information provided will be treated as Confidential. We always aim to contact you within two working days.

 

Are you completing this form on behalf of yourself or someone else? *
Please complete this field
If you are completing the form for someone else, what is your relationship to them?
Tell us about the person who has or had the problem with the NHS in North Yorkshire. If this is not you then we'll ask for your details later:
Complainant's name *
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Address *
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Postcode
NHS number (if known)
Telephone number (if any)
Mobile phone number (if any)
Email address (if any)
Brief details of the NHS related issue
Any other comments?
Preferred method of first contact
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If you've suggested a phone call, when is the best time to phone?

If you are unable to answer, do we have permission to leave an answerphone message?
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If you have filled in this form on behalf of someone else, write your details here:
Name
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Phone number
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Email address
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