COMPLIMENTS, CONCERNS, OR COMMENTS

Please use this form for compliments, concerns and comments only. If you have a personal or other clinical query please contact reception and arrange an appointment or a telephone consultation with a doctor or nurse.

Personal Details

Name: Date of Birth: Address: Postcode: Daytime Telephone Number: Mobile Telephone Number: Email Address:

Concern / Comment / Compliment

My query relates to:

Patient Details (if different to above)

Name of Patient: Date of Birth: Address: Postcode: Daytime Telephone Number: Mobile Telephone Number: Email Address:

Service

Type of Service: Name of Service: Address of Service:

Details of the event

The event raises either a concern, comment or compliment

What would you like to happen as an outcome

My ideal outcome would be

Send Your Request

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form

Register with Parkshot Parkshot Pathways Request a Prescription Covid-19 Information Conditions & Treatments Find Local Services Website Accessibility

18 Parkshot, Richmond, Surrey, TW9 2RG

Telephone: 020 8948 4217 Out of Hours Information

Menu