Patient support and complaints online form (Bristol and Weston hospitals)

If you have any comments, complaints, compliments or suggestions about the services we provide in Bristol or Weston - please tell us by filling in this form.

We will always treat the information you send us with the strictest confidence and will not pass on any information to third parties.

Please complete all of the fields below

Date form completed

Date of event (if appropriate)

Brief details of complaint, compliment or suggestions about our services (we will contact you if further information is required)

First name

Surname

Your address

Telephone number

Email address

Name of patient (if different)

Address of patient

Relationship to patient (if relevant)

Telephone number of patient

Date of birth of patient

Consultant/specialist of patient

Hospital/ward/department

I consent to having my information stored for the purpose of this online support/complaint form. I know you may need to contact me in relation to my form. I understand that if I don't consent I cannot submit online.