Patient Feedback Form

This form will be sent to the Practice Manager, or their deputy in their absence. They will repsond to any complaints according to the timescales set out on our complaints page here - Complaints Procedure

Any other type of feedback will be responded to in a timely manner allowing for staff absence through sickness/holidays etc. Thank you for contacting us.

Last Updated: 07/06/2024

Your Details

Name *

Date of Birth *

Phone Number *

Email Address *

Feedback

Type of Feedback *

Compliment

Suggestion

Complaint

Question

Other (Please Specify)

Your feedback

THIS FORM COLLECTS YOUR NAME, DATE OF BIRTH, EMAIL, OTHER PERSONAL INFORMATION AND MEDICAL DETAILS. THIS IS TO CONFIRM YOU ARE REGISTERED WITH THE PRACTICE, TO ALLOW THE PRACTICE TEAM TO CONTACT YOU AND ALSO TO UPDATE YOUR MEDICAL RECORDS HELD BY THE PRACTICE AND OUR PARTNERS IN THE NHS. PLEASE READ OUR PRIVACY POLICY TO DISCOVER HOW WE PROTECT AND MANAGE YOUR SUBMITTED DATA. *

I consent to the practice collecting and storing my data from this form.

This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Cookies on the Murrayfield Medical Practice website

Patient Feedback Form

Further Information