Home » Departments » Patient Complaints and Comments » Complaints Form

 

We Value Your Opinion

If you wish to make a comment, compliment or complaint, please complete the online request form below and press submit at the bottom of the form. Alternatively you can either post or email your details for the attention of the Patient Liaison Officer.

Email: patient.complaints@sivuh.ie . (If you have not received an acknowledgement within 7 working days please contact us to ensure we have received your email)

 


Please enter information into the form below and click on submit. * Denotes Compulsory Fields

*Name of Service / Department:

*Date of Experience:

*Details:


For the Purpose of investigation of my complaint I Grant permission to the SIVUH to acces my personal patient confidential information. This may be necessary in some cases to fully investigate your complaint.

Grant Permission ? (yes or no)

Please complete your details below:

*Name:

*Address:


*Contact No.:

Email Address:

MRN No (if Known).:


Note:

In the case of a complaint being made on behalf of a third party please give details of this person (name and Address) in order that consent can be obtained

 

Details of 3rd Party

*Name:

*Address:


 


 

Page last updated: 20/03/2020
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South Infirmary

Victoria University Hospital


A teaching hospital

of University College Cork