GP at Hand - Feedback form
Please use this form to let us know your feedback, whether that is to tell us about issues, concerns or compliments. 

We aim to acknowledge all feedback within 3 working days and respond in full (where required) within 28 days.

Please do not use this form to send us any clinical requests, this is for feedback only.
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Email *
Your full name  *
Your date of birth *
Your NHS number (if you know it)
Name and date of birth of person to whom this feedback relates (if different) 

Please note, if you are providing feedback on behalf of someone else and require us to reply, we will need permission from the person to whom the feedback relates in order to do so. We will contact you and them if this is required. 
Date your feedback relates to  *
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Summary of events  *
What you wish to achieve *
Name of member of staff involved (if required)
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