Comments and Suggestions Form

This form is only to be used for general feedback and opinions. If you have a medical query please contact the surgery on 4062 3303. If you wish to make a formal complaint please follow the surgery complaints procedure (see below)

What kind of comment would you like to send? Remember this form is not for medical matters.
Your comment is:	Please choose an option A Suggestion Praise Regarding a Problem Other
What would you like to say?
Enter your comments in the space below

Your contact details
Your Name:
Your Email:
Your Telephone:
Do you agree to be contacted regarding this matter?
Yes, I agree that the practice may contact me regarding this matter
Recaptcha:

About This Form

Note that by using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your comment.

Your IP address (3.145.52.86) will be sent with your communication. In rare cases where abuse or criminal activity can be shown to have taken place this may be used by the authorities to trace you.