Complaint form

Dear sir, madam,

You have a complaint about the services we provide in one of our centres or about an employee of ours. You can submit your complaint to us with this complaint form.

Our complaints coordinator will review your complaint and inform you about the completion.

Your data:

Name complainant

Zorgnummer

Location GC A

Address

Phone number

E-mailaddress

Contact information:

Name contact

Address

Phone number

Relation

Complaint:

Date

Time

Complaint description

Unfortunately the submission of your complaint has failed.

This is caused by one or more of the following reasons:

The form hasn't been submitted within 24 hours.
One or more fields contained the forbidden strings: [url, http of href.

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