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Online contact form

You may use this form to register a complaint about the services provided to you or on behalf of someone else by Derby Teaching Hospitals NHS Foundation Trust. If you would like further advice or help with completing this form please contact the Patient Advice and Liason Service or freephone 0800 783769.

Alternatively, if you require and independent assistance or support during the complaints process, you can contact Oneadvocacy at the Derby Citizens Advice and Law Centre, an advocacy service for the Derby City Area. They can be contacted on 01332 228700 or visit the website http://www.oneadvocacyderby.org

If you live in the wider area of Derbyshire, you can contact Derbyshire Mind ( NHS ComplaintS Advocacy ). Telephone: 01332 623732 or E-Mail advocacy@derbyshiremind.org.uk or the website http://www.derbyshiremind.org.uk

Please fill in the fields below:

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Complaint Form

1. About You

Title »

2. Your Address

3. Your contact details

4. Are you complaining on behalf of yourself?


If YES go to Section 5 

If NO, please provide details of the person you are raising concerns about.

5.  Details of complaint

6.  Please state the specific questions/issues which you would like us to investigate and respond to

How we will respond to the concerns you have raised 

Upon receipt of your completed complaint form, one of our Complaint staff will contact you.  This will be to personally discuss your experience, talk about any issues regarding consent or timescales for responding to you, and whether you would like our response to be in writing or if you would prefer a meeting.


Consent/Disclaimer when communicating via email.  

If you wish to communicate via email about your complaint/concern you must accept the risks associated with this.  

Nhs.net is an approved secure encrypted email system for use by nhs staff when exchanging patient data. When using this email system to communicate with other non encrypted email systems, such as that of a patient, or for testing, the transmission cannot  be guaranteed 100% secure or error free. Information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. Derby Teaching Hospitals and their employees do not accept liability for any errors or omissions in the  contents of messages, which arise as result of email transmission.

Please confirm by ticking this box  »