Online Form

Make a Comment, complaint or compliment

If you wish to make a comment, complaint or compliment about our services or the care you receive, please use the form below.

All fields listed with an * are required. If any required fields are blank, your form will not be submitted.

Do you wish to make a *

Comment
Compliment
Complaint
Other

Title:

Full name: *

House number/name: *

Street/Road *

Town/City: *

County:

Postcode: *

Email: *

Telephone:

Please provide details of your comment, compliment or concern: *

If you are raising a concern or complaint, what outcome do you wish for?

If you would like a reply, how do you wish us to contact you?

Email
Letter
Phone call (please give your number)

Have you contacted us previously about this issue?

Yes
No

If you are making a complaint please tell us who you are

Service user/patient
Acting on behalf of a service user/patient
Carer
Other

If you are not the service user, please provide their name and your relationship to them

Your date of Birth

Date of Birth of patient

Do you consider yourself to have a disability?

Yes
No
Rather not say

Does the service user/patient consider themselves to have a disability?

Yes
No
Rather not say

If yes do you have:

Physical impairment
Sensory impairment
Learning disability
Mental health issue (long term)
Other health conditions (long term)

Consultant/Specialist of Patient

Hospital and Ward/Department

Equality Information

Any other ethnic group

Ethnicity of Patient

Any other ethnic group (patient)

What is your gender?

Male
Female
Rather not say

What is the service user/patient's gender?

Male
Female
Rather not say

Please ensure you have filled in all required fields (listed with an *). If any required fields are blank your form will not be submitted successfully. To submit your form, please click the green "submit" button below.

On successful submission of the complaints form you will receive the following message

"Thank you. Your complaint, compliment or comment about our services and the care you receive has now been sent to the Hertfordshire Partnership University NHS Foundation Trust PALS and Complaints team."

If you are experiencing problems submitting your form please contact 01707 253916 or email hpft.complaints@nhs.net

Related Pages

Online Form

Make a Comment, complaint or compliment