Compliment or Positive Comment Form

Last Updated: 11/04/2024

Your Details

Please tell us which is your usual surgery *

Arnewood

Barton

New Milton Health Centre

Webb-Peploe

Your full name including forename, surname and any middle names *

Patient name if different

Date of birth *

Contact telephone number *

Contact address *

Contact email address

Confirm contact email address

Add Your Compliment or Positive Comment Here:

Write Your Compliment or Positive Comment Here: *

Important Information

This form collects your name, date of birth and email address. This is to confirm you are registered with the surgery and to allow the surgery team to contact you. You may also have shared personal or medical information.

Please read our 'Privacy Notice' and 'Data Sharing Policy' to discover how we protect and manage your submitted data.

See Our Privacy Notice and Data Sharing Policy - Coastal Medical Partnership

I consent to the practice collecting and storing my data from this form *

Yes No

I understand this form is to make a compliment or positive comment and is not a way to make a general 'request' for other matters. I also understand that if I use this form for anything other than a compliment or positive comment, it will be disregarded and I will not receive a response. *

Yes No

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Compliment or Positive Comment Form

Further Information