Patients & Carers

Raise a Concern/Complaint

We want to hear your views

If you need help completing this form, please telephone 0117 340 3741 or 0117 340 3076, or email complaints@nbt.nhs.uk


Is this a*	Concern Complaint
Date complaint form completed:*
Date of incident/event:
Name of person making complaint:*
Address of person making complaint:
Telephone of person making complaint:
Name/Address of patient (if different):
Patient hospital/NHS Number:
Telephone number of patient:
Relationship to patient (if relevant):
Date of Birth of patient:
Ethnicity of patient:
Consultant/Specialist of patient:
Hospital, Ward/Department:
If the person making the complaint is not the patient, we will require signed consent from the patient to take this forward on their behalf. If this is the case, when we have received this form, we will send you an acknowledgement letter and a consent form to be signed by the patient. In order for your formal complaint to be investigated, please complete the remainder of this form and then click on the Submit button.
Please provide an account of the incident(s):
State the areas you would like investigated:
What outcomes do you wish from this?:
Submit

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Contact ACT

Advice & Complaints Team (ACT)
Trust Headquarters
Frenchay Hospital
Beckspool Road
Frenchay
Bristol
BS16 1JE
Telephone: 0117 340 3741 or 0117 340 3076
Telephone/Fax: 0117 340 6646
Fax: 0117 340 6561
Email: complaints@nbt.nhs.uk