Complaints Form

Full Name

Date of Birth

Email address

Are you making the complaint on behalf of another patient?

Please describe in as much details as possible the clear details of your complaint ie the main issue with the medical advice/treatment/service you have received and exact details what happened including any dates, times, who was involved

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Leander Family Practice • 949 London Road, Thornton Heath, Surrey, CR7 6JE.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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