Need a GP in evening, night or weekend?

 
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Did you have an excellent experience with (the care provision) at The After Hour General Practitioners Clinic and you want to let us know? Use the form below.

 

  
 Contact  
 Date and time of contact 
 Name of staff and/or GP 
  
 Patiënt information 
 Given name 
 Additive 
 Surname 
 Date of birth (dd-mm-yyyy) 
 Full address 
 Postcode 
 Woonplaats 
 Country of residence 
 E-mail address 
 Telephone number 
  
 Complaint 
 Your complaint (max. 1024 letters)
Clearly mention the reason for your complaint and the basis thereof.
 
 
  

Compliments

Please fill in the form completely so we can pass on the compliment to the correct  person. Thank you for your appreciation and feedback.

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