FELLVIEW HEALTHCARE LIMITED IN-HOUSE COMPLAINTS FORM. If you need help to complete the form please ask the Branch Manager for assistance.

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1 FELLVIEW HEALTHCARE LIMITED IN-HOUSE COMPLAINTS FORM Note It is important for the practice to get as much information as possible about the nature of your complaint so that we investigate thoroughly and look at ways of improving our service. In order to do this we need as much information as possible (including date/time of complaint, nature of complaint etc). If you need to use a continuation sheet, please staple this at the back of the form. If you need help to complete the form please ask the Branch Manager for assistance. COMPLAINANT DETAILS Name of Complainant:. Address:. Post Code:.. Tel Number:. PATIENT DETAILS (IF DIFFERENT FROM ABOVE) Name of Complainant:. Address:. Post Code:.. Tel Number.. DETAILS ABOUT THE COMPLAINT Who is your complaint about: (Dr/Nurse/Receptionist etc)... Date/Time of Complaint:.. Place of Complaint: (i.e. Reception, consulting room).

2 NATURE OF COMPLAINT (Please give as much detail as possible about the complaint) Signed:.. Date:

3 CONTACT DETAILS HOW WOULD YOU PREFER THE PRACTICE TO CONTACT YOU REGARDING YOUR COMPLAINT:- Telephone/ /Letter* *Please delete as necessary Telephone Number (if applicable) Address (if applicable).. WHERE THE COMPLAINANT IS NOT THE PATIENT:- I,.. (name) hereby authorise the above complaint to be made and I agree that member of the practice may disclose (in so far as is necessary to do so to answer the complaint) conditional information about me which I provide to them. Patient s signature: Date:. FOR PRACTICE USE ONLY:- Date Complaint Registered:.. Date acknowledged: (3 working days) Date of Meeting to Discuss the Complaint:. Agreed Timescale for Complaint to be investigated:. Date of Written result of Investigation being sent out :

4 COMMENTS LOG: (To be used to list dates/times when practice has contacted patient if there are problems with concluded the investigation during the agreed timescale)

5 Fellview Healthcare Limited aims to provide its patients with the best care it can, but we may sometimes fall short of the mark. If you have any concerns or complaints, we want to hear about it so that we can improve our services. Patients have the right to choose whether they wish the practice or Best Life Independent Advocacy NHS Complaints to deal with their complaint. (Contact details are given at the end of this information leaflet) Patients cannot make a complaint to both parties, nor can they have their complaint dealt with by one party and then seek to have the same complaint dealt with by the other party. If you have a complaint we would encourage you to speak to whoever you feel most comfortable with your doctor, nurse, receptionist or the Branch/Practice manager. However if you would prefer to give your feedback in writing, please ask the receptionist for one of our In-House Complaints forms. If you need any help in completing this form please ask our Branch Manager for some guidance. Please return your completed form to the receptionist. If you have a complaint to make, please do not be afraid to say how you feel. We welcome feedback to help us improve our standards and you will not be treated any differently just because you have made a complaint. We will do our best to put things right as quickly as possible. The practice is not able to deal with questions of litigation, compensation or employment issues. If you make a complaint to the practice the following criteria will apply:

6 . Your complaint will be acknowledged within three working days. (The acknowledgement will include the offer of a discussion (which can be either telephone or a face-to-face meeting) to agree a plan of how the complaint will be handled and agree reasonable timescales for investigating and concluding the complaint.) If you do not wish to discuss the issue, the practice will decide how the complaint will be handled based on the available information.. The practice will keep you informed throughout the investigation especially if the agreed timescale for investigating the complaint cannot be met.. Once the investigation has been concluded, a letter (or, with the complainants consent an ) will be sent to you setting out how the complaint has been investigated, the evidence considered and the conclusion reached. This letter will include details of actions the practice has and will be taking as a result of its findings. It will also confirm if the practice feels that there is nothing more they can do concerning your complaint.

7 ADDRESS DETAILS Best Life Independent Advocacy NHS Complaints 4-6 Oxford Street Workington Cumbria CA14 2AH Tel: Web Address: complaints

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