Online feedback form

Your feedback for us

Your feedback is important to us. It tells us how we can improve and what we’re doing well.

You can give your feedback by filling in this online form. You don't have to give us your name or contact details. But if you don't, we won't be able to respond to you.

Your feedback is confidential. We won't link or record it in your health record.

Learn about other ways to give feedback and how we treat your feedback.

Section 1: About you

Do you want to remain anonymous? * Choosing to remain anonymous might mean we can’t fully investigate your feedback. We still record and review all feedback.

I'm a: *

Patient
Visitor
Staff member
Other – please specify below

Other If you selected other, tell us how you're connected to our hospitals or services.

Your name

Your address

Your email address We'll use your email address to reply to you. We won't use it for any other purpose.

Your phone number We'll use your phone number to call you about the feedback you’re giving us. We won't use it for any other purpose.

Are you giving feedback on behalf of someone else? *

Yes – go to Section 2
No – go to Section 3

Section 2: Patient details

Patient's full name You only need to fill in this section if you're giving feedback on behalf of someone else. We may need to contact them and ask permission to discuss their health with you, or access their medical records.

Patient's date of birth This helps us to review the person's health record when investigating compliments or complaints.

Day Month Year

Patient's phone number

What's your relationship with this person?