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Church Langley Medical Practice
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Compliments & Complaints Form

Before you complete this form, we strongly encourage you to contact the surgery by phone to discuss an complaint. This is to try and best understand and resolve your complaints, and doing this in a timely manner.

However if you have done this already and would still like to complete a written form please complete the form below. Once we recieve your completed form, we will notify you of the receipt of your compliment/complaints within three working days. We will also aim to investigate your complaint within 30 days and get back to you in that time. However, sometimes the process may take longer to investigate the matter and in such cases we will inform you and keep you updated on the process.

Your Details
DD/MM/YYYY
Please provide the best number to contact you.
This is in order to keep you updated about the progress of your complaint
Details of the Patient (if different to the details above)
In case of another adult, you need to have the consent of the individual to represent in the case of a complaint
DD/MM/YYYY
Details of the Compliment/Complaint

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Church Langley Medical Practice

Church Langley Way, Harlow, Essex, CM17 9TG

  • 01279 638520
© Neighbourhood Direct Ltd  2025
Website supplied by Oldroyd Publishing Group

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Local Services
Residential/
Nursing Care
Residential/
Nursing Care Jobs
Financial
Protection
Physio
Advertise Your
Business Here