Feedback Form

All the GP Practices in the South Warrington Network are working hard to provide a safe, effective, efficient and personable service for their patients. Your feedback is always welcomed and appreciated to ensure that we are getting this right. If you would like to send us your feedbackplease complete the form below.

Feedback Form

Name of person leaving feedback:

Patients Name if different: (Patients consent is required if they are over 16)

Relationship to Patient:

Patients date of birth:

Contact telephone number:

Today’s date:

Date feedback is relating to:

Feedback:

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.

I consent to my information being used for the purposes described above and wish to submit this online form to Latchford Medical Centre • 5 Thelwall Lane, Latchford, Warrington , WA4 1LJ.

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.