Complaints form

Make a complaint

Please make sure you provide below an email address or phone number (or both) so we are able to reply as we are unable to reply directly to these submission forms. We will acknowledge your complaint or feedback within three working days and provide more information about the complaints process. You can also contact us on 020 3069 0240 or [email protected]. Please contact us via the above details if you have any issues navigating this form. If you are an LAS member of staff, please do not complete this form. Please use Datix.

Incident date - if applicable - must be dd/mm/yyyy format
DD slash MM slash YYYY

If you do not the exact date please add a rough estimate.
Your name
First Last
Phone
Email * REQUIRED
Patient's name (if different)
First Last
Please fill in this box if the complaint relates to patient care. Please leave empty if this complaint does not relate to care of a patient.
Patient's date of birth - must be dd/mm/yyyy format
DD slash MM slash YYYY
Address (if known) of incident or location
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your relationship to the patient
Details of your complaint * REQUIRED

Information about the way that we use the data that you provide can be found in our privacy policy.