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Complaints form

The After Hours General Practitioners Clinic have an internal Complaints regulation defined on the Complaints form.

  
 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.
 
  
  

Complaints

Fill in the form completely and clearly state the reason for the complaint. Unfortunately we can't  attend to incomplete forms.

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