Please note that the form that you should use depends on who you are and the nature of your complaint.

For patients

• Print out and complete the Independent review request form. Remember to tell us what happened, when it happened, where it happened and who was involved.
• You also need to send a completed Consent form IR 075 - for complaints on behalf of yourself, which gives us permission to ask for a copy of your medical records and information held in the trust's complaint file.
  

Complaining on behalf of the patient

• Print out and complete the Independent review request form. Remember to tell us what happened, when it happened, where it happened and who was involved.
• Please complete the appropriate consent form (see below), which gives us permission to look at the patient's medical records and information in the trust's complaint file.

A complaint that is not about an individual patient

• Print out and complete the Independent review request form. 
• Print out and complete the Consent form IR 080 - for complaints not related to patient treatment.

Please send your completed forms, along with copies of the additional information asked for in the request form, to: Complaints investigation team, Healthcare Commission, FREEPOST BAT 18958, Manchester M1 9XZ.

Sending a consent form on behalf of the patient

If you are asking us to look into a complaint on behalf of a patient, please choose the appropriate consent form from the list below and return it to us at the Freepost address shown above:

• Consent form IR 090 - for complaints on behalf of someone else
• Consent form IR 095 - for complaints on behalf of someone who cannot do so themselves
• Consent form IR 065 - for complaints about care of a child
• Consent form IR 070 - for complaints about a patient who has died
• Consent form IR 085 - for an Ombudsman's referral complaint
• Consent form IR 100 - for complaints by prisoners

Diversity monitoring form

Because we are committed to equal opportunities, we collect and monitor information about people who ask us to review complaints about the NHS. This is why we ask you to complete a diversity monitoring form and return it with your request form. We will treat the information you give us in confidence and only use it to check that our policies and systems do not unfairly discriminate against or have an adverse impact on any group. Go to the Diversity monitoring form.

How we use your personal information after your consent

We only use personal information about people in our work in ways that are allowed by the Data Protection Act 1998 and other legislation. For more information, including about what you are consenting to when you send us a completed consent form, click on the link below. Go to the Consent information leaflet.

Requesting a review by letter

Please use our request form if possible, so we can be sure that you give us the information we need to review your complaint. But if you prefer you can make your request by letter instead, addressing it to: Complaints Investigation Team, Healthcare Commission, FREEPOST NAT 18958, Manchester M1 9XZ

More information

For advice on reviewing your complaint, please contact our Helpline on 0845 601 3012 (open from 9am to 5pm, Monday to Fridays except bank holidays) or email: complaints@healthcarecommission.org.uk

More information is available in the following leaflets:

• What to do if you are not happy with the way the NHS has dealt with your complaint 
• What to do if you are not happy with the way the NHS has dealt with your complaint (large print version)
• Easy read version of our complaints leaflet and independent review request form 
• Independent review request form - large print (updated February 2008)
• Easy read consent form IR 075 - for complaints on behalf of yourself
• Easy read consent form IR 090 - for complaints on behalf of someone else
• Easy read consent form IR 095 - for complaints on behalf of someone who cannot do so themselves
• Easy read consent form IR 065 - for complaints about care of a child
• Easy read consent form IR 070 - for complaints about a paitent who has died
• Easy read consent form IR 085 - for an Ombudsman's referral complaint
• Easy read consent form IR 100 - for complaints by prisoners
• Easy read consent form IR 080 - for complaints not related to patient treatment
• Easy read consent, confidentiality and data protection - consent information leaflet