Patient feedback

Have you had help from the practice recently?

Let us know how well we did by using the form below.

Please do not use this form for complaints. If you have a complaint click here for details on our complaints procedure

Thank you.

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Patient feedback

Overall rating

Feedback

Name (optional)

Telephone Number (optional)

Email (optional)

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 Portland Medical Practice • Anchor Meadow, Aldridge, Walsall, West Midlands, WS9 8AJ.

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.