Formal Complaints Form

If you are unhappy and wish to make a formal complaints then please complete the form below. The Practice Manager will contact you within 3 working days.

Full Name

Telephone Number

Email Address

Details of your 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.

I consent to my information being used for the purposes described above and wish to submit this online form to Brace Street: Dr Kumar & Dr Kasliwal • 63 Brace Street, Brace Street Health Centre, Walsall, WS1 3PS.

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.