Submit your concern or complaint | Alliance for Better Care

How can we help?

Your full name *

Your email *

Your telephone number

Are you completing this form *

For yourself
On behalf of someone else

This form is submitted on behalf of the following:

Your date of birth (DOB)

Your postcode

The service / team you are referring to *

Please give us a description of what has gone wrong and how we can help *

The date of the event or incident which has prompted you to report a concern or complaint (if relevant)

It may help us if you can give us the names of any staff involved

Please upload any supporting information that might be useful as a reference for our team to assist you

Click or drag a file to this area to upload.

Due to the Data Protection Act and patient confidentiality responsibilities, we cannot disclose any information to a third party without the written consent of the patient. If you are complaining on behalf of a relative or friend, please ask them to complete our consent form in order for us to discuss details of their care.

Patient Consent Form →