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Ask, Listen, Do 2024

1. Ask-Listen-Do

This is a form for your feedback, concern or complaint.

 

If you want to call us instead please phone 01227 783145 and speak to a member of staff.

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Question 1.

Please tick to say what you are writing about  

- Required.
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Question 2.

I am writing about (please tick one) 

- Required.
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Question 3.

Name of hospital and service (ward or department)

- Required.
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Question 4.

When did it happen? (date or month/year) 

- Required.
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Question 5.

What happened? How did it make you feel?

- Required.
This is required
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Question 6.

What would you like to happen next? (For example would you like somebody to contact you or would you like some action taken regarding your experience?)

- Required.
This is required
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Question 7.

What would help you in the future?

- Required.
This is required