Skip to Main Content

Compliments and complaints form

Name
This field is for validation purposes and should be left unchanged.
Nature of Feedback*
Please select from the following:
- Complaint
- Compliment
Name
First Last
Email
Patient/client name
First Last
Your comments
Your address
Street Address Town/City County Postcode
Patient/client address
Street Address Town/City County Postcode
Your daytime phone number
Patient / client date of birth

Day
Month
Year

Northern Health and Social Care Trust

Bretten Hall
Antrim Area Hospital
Bush Road
Antrim
BT41 2RL

Accessibility Statement Cookies Disclaimer Contact us Site Map