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NHS Complaint Standards sample forms

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Consent for patient or service user making their own complaint

Use this form to explain that other relevant people inside (and potentially outside) your organisation may need to see information from a complaint as part of your investigation.

[WORD 1.04MB]
Consent for a representative to act on someone’s behalf

If the person is using a representative, you need to follow confidentiality and data protection laws. The person needs to authorise the representative to act on their behalf. They must also authorise you to discuss their complaint and share their personal information with the representative. Use this form to help you.

[WORD 1.05MB]
Right to access information when the person cannot provide consent

Use this form if the person affected does not have the capacity to consent to the complaint being made on their behalf.

[WORD 1.04MB]
Complaints against multiple organisations (including health and social care)

Use this sample consent form to gain permission to share the person’s details with other organisations. 

[WORD 1.04MB]

 
Consent for an advocate to act on someone’s behalf

Anyone who makes a complaint to the NHS is entitled to an independent complaints advocate. If the person is using a advocate, you need to follow confidentiality and data protection laws. The person needs to authorise the advocate to act on their behalf. They must also authorise you to discuss their complaint and share their personal information with the advocate. Use this form to help.

[WORD 1.04MB]
Easy Read consent

This is an Easy Read version of the consent form.

[WORD 1.4MB]
Capturing complaints at early resolution

Use this form to make a simple record of an early resolution complaint, including the outcome, and any action taken to resolve the issue and improve services.  

[WORD 1.04MB]
Statement of consent for sharing my information with other organisations

Use a joint consent form to cover sharing personal information and any learning across all organisations involved. This means the person raising the complaint only needs to provide consent once. 

[WORD 1.04MB]
Capturing insight and learning from a complaint

Use this form to capture insight and learning from a complaint. They will help organise your data so you can use it in reports to senior leaders or in your annual report.

[WORD 1.04MB]