Croft Hall Medical Practice

Comments or Suggestions

If you would like to leave us some comments about the practice, you can do so using the form below. Alternatively, click here to download a printable copy.

Please note:

1. Enquiries about medication or appointments will not be replied to.  
2. It is always helpful if you could leave us your personal details on the form but if you do not wish to, please just complete the comments box.

1Comments or Suggestions

Your name

Date of Birth

Are you able to provide your NHS or Patient Number?Please Choose...I have my NHS NumberI have my Patient NumberNot Sure / Don't KnowThis will allow us to locate you quickly on our Patient Database.

NHS Number

E-mail Address

Postcode

Home Telephone Number

Mobile Number

GenderPlease Choose...MaleFemale

Which of the following ethnic backgrounds do you most closely identify with?Please Choose...White: British GroupWhite: IrishMixed: White & Black CaribbeanMixed: White & Black AfricanMixed: White & AsianIndianPakistaniBangladeshiCaribbeanAfricanChineseAny Other (please specify)

Please provide details if you selected 'Any Other'

How would you describe how often you come to the practice?Please Choose...RegularlyOccasionallyVery Rarely

General Queries/Comments/Suggestions/Concerns etc

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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 known only to the GP practice and is accessed over a secure connection by nominated Practice staff. Our practice has 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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