Please complete the questions below so we can investigate your complaint. First Name* Last Name* Email Address* Your Address* find How would you like to be addressed on future correspondence?*MissMrsMsMrOther (please specify) How would you like to be kept informed on the progress of your complaint?*EmailPostThrough an agreed third-party representative (please specify)Other (please specify) Do you give us consent to access your Auris Ear Care records?*YesNo Do you have any disabilities that we should consider throughout this process?*NoYes (please specify) Please describe as fully as you can the nature of your complaint stating: - Specific details of the complaint - The date and time of the event - Names of those present at the time, if known What outcome are you hoping for?* All complaints received will be investigated in the strictest confidence. You will receive a written acknowledgement of your complaint within 3 working days. We will carry out an investigation and write to you about this within 20 working days. If we cannot give you a full response within 20 working days we will write to you to explain why. Once the complaint is resolved, a further full written response will be made within 5 working days of a conclusion and outcome being reached.