Complaint Form – Ontime Healthcare

Anonymity Option:

Would you like to tell us who you are?

Yes

No. Ill stay Anonymous

We respect your wish to remain anonymous. However, if you would like to get some updates or feedback from us regarding this complaint, you may need to tell us a way through which that can be possible.You may tell us any way that does not breach your anonymity.

Personal Details

Suffix

*Name

*Surname

*Email

*Phone

About the Complaint

*What is the complaint about?

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Conduct of staff member

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Lateness

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Facilities or Equipment

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Other

Name / Description (if known)Please provide specific name or description of the person or item involved

What Happened?Give details of the complaint

File Upload (Multiple files allowed)

X

Would you like to suggest a way to resolve this matter?

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Yes

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No