News Events Publications Media Donate Home Our service Get involved About us Join our team Contact us Home > Contact us > Healthcare professional (HCP) and social care complaint/enquiry form Healthcare professional (HCP) and social care complaint/enquiry form For healthcare professionals and social care providers to raise any concerns or complaints regarding a service we've provided. Share this page Please use this form to record any incident you wish to make on behalf of your organisation in relation to the care we have provided, giving as much information as possible. To ensure we are able to gather the information in a timely manner please choose the exact service you are referring, choosing the risk score you believe it should be handled. Name(required) Job title(required) Organisation / Practice(required) CCG(required) Address(required) Contact number(required) Email(required) Date(required) Patient details (where necessary) Please give name, address and date of birth OR NHS number Name Address Postcode Contact number Date of birth Sex Male Female NHS number (if available) Date of incident Time of incident : AM PM AM NWAS incident number (if known) Service provided by NWAS PES - emergency ambulance (999) PTS - patient transport service Urgent care VAS - voluntary aid sector (eg, St John) Details of incident (please do not use abbreviations) Patient outcome (without patient outcome, we cannot investigate this incident thoroughly/ in its entirety)(required) File upload Drop files here or Select files Max. file size: 32 MB. For associated files such as incident report forms or patient report forms Risk score (download risk score matrix below)(required) Consent(required) I have read, understood and agree to the terms outlined in the privacy policy. Risk score matrix Also in this section FOI and EIR General enquiries Lost property Make a complaint Healthcare professional (HCP) and social care complaint/enquiry form Point taken Send a thank you Tell us about your defibrillator CardiacSmart Accredited and Accredited+ application form CardiacSmart Accredited partner application form Tell us how we did Contact us General enquiries 0345 112 0999 These numbers should NOT be used to contact us in an emergency. In an emergency dial 999 immediately or for non-urgent medical advice call NHS 111. How to find us Directions to our offices Help Privacy policy Freedom of Information Contact us Green Room © Copyright 2021 North West Ambulance Service NHS Trust . Lovingly crafted by Mixd