Submit a Complaint

Please include an email address, phone number, or both when submitting this form, as we are unable to respond directly through form submissions without these details. NIAS processes new complaints between 9.00am and 2.00pm, Monday to Friday (excluding bank and public holidays). If your complaint is received during these hours, we will acknowledge it within this timeframe or by 2.00pm the next working day. Complaints received outside of these hours, over weekends, or on bank/public holidays will be acknowledged the following working day. If you experience any issues completing this form, you can contact the Service User Feedback Team on 028 9040 0999 (Monday to Friday, 9.00am to 2.00pm), or by email at complaints@nias.hscni.net.

Company

This field is for validation purposes and should be left unchanged.

Incident Date

(If you do not know the date, please add a date you think is close)

Your Name(Required)

First Last

Phone

Email(Required)

Enter Email Confirm Email

Are you completing this form on the behalf of the patient/does your feedback relate to another individual?

Yes

N/A

To complete a Third Party Consent Form click here. To complete a Consent Form for an Elected Representative click here.

Patient's Name

(if different)

First Last

Patient's Date of Birth

(please fill in this if your feedback relates to patient care)

Address/Location of the Incident

Address Address Line 2 City/Town County Post Code

How would you like us to contact you to thank you for your feedback and advise you of the next steps?

Phone

Post

Is the patient aware that you're providing this feedback on their behalf?

Yes

N/A

Details of your complaint(Required)

As a result of this feedback, what action would you like taken forward?

Information about the way we use this data can be found in our privacy notice