Patient Complaints Form

This complaint form gathers the information we need to review your complaint. When you make a complaint to Tararua Health Group, we will assess your complaint and work with you to resolve it. Please know that if you make a complaint, we will discuss it with the person or practice team you are complaining about.

Title

Select

First Name

Family Name

Postal Address

Mobile Number

Email Address

Do you have a preference for how we contact you?

Where did the event occur?

Select

Date

Time

Who was involved?

Would you please tell us the nature of and the reason for your complaint?

What are your expectations regarding your complaint?

What actions do you believe we should take with your complaint in mind?

To the best of my knowledge everything I have said regarding this complaint is true.

The information on this form is requested to enable your complaint to be investigated. The information collected will only be made available to those individuals who can contribute to the resolution of your complaint Information will be stored in a secure environment for up to ten years and will not be accessed by people not directly involved in the investigation or resolution of the complaint.

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