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YOUR FULL NAME
TELEPHONE NO. HOME & MOBILE
NHS NO.: )
HOSPITAL NO.: ) if known
PATIENT’S DATE OF BIRTH )
(Name of Chief Executive)
Chief Executive of named NHS Trust
Name of Hospital
Re: (insert) PATIENT’S NAME, DATE OF BIRTH AND ADDRESS
I am writing to make a formal complaint about my NHS care or treatment received at:
1)(insert) – HOSPITAL & WARD/DEPARTMENT WHERE INCIDENT HAPPENED
- Should you be complaining about a specific member of staff, you will need to include their
full name and position if known.
2) (insert) – INFORMATION ABOUT THE COMPLAINT
- Details of exactly what happened and when it happened.
- Date/s of incident from when the complaint arose.
- Dates of any appointments, admissions/discharge in relation to the incident/s in question.
- Reason for treatment and/or admission.
- Include names and positions of people involved, if relevant.
- If you are complaining about any type of delay (for example if you had to wait for treatment or for
a doctor to see you) then you should specify approximately how long the delay was (if known).
- Should the events be very detailed then list the main points in chronological order in this letter.
- Include all important and/or relevant details. Don’t leave anything out.
- Attach any documentation and/or evidence that you wish to rely upon in support of your complaint. Only send copies, not originals.
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