Comments and Suggestions Form

Please only use this form for comments and suggestions as to how we can improve our service to you. Medical matters and official complaints cannot be dealt with via this form. For medical queries, please make an appointment to see the appropriate clinician. For compliaints, please contact our practice manager, Miss Barbara Milby either by telephone on 01505 683591, or in writing - Miss B Milby, Practice Manager, Kilbirnie Medical Practice, 2-4 Kirkland Road, Kilbirrnie, Ayrshire, KA25 6HS.

What kind of comment would you like to send? Remember this form is not for medical matters.
Your comment is:	A Suggestion Praise Regarding a Problem Other
What would you like to say?
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Your contact details
Your Name:
Your Email:
Your Telephone:
Do you agree to be contacted regarding this matter?
Yes, I agree that the practice may contact me regarding this matter
The practice has no email address defined. Comments cannot be sent.

About This Form

Note that by using this form, you will be sending information about yourself across the Internet. Whilst every effort is made to keep this information secure, you should be aware that we cannot offer any guarantees of absolute privacy. If this matter concerns you then you should use another method to notify us of your comment.

Your IP address (100.26.179.196) will be sent with your communication. In rare cases where abuse or criminal activity can be shown to have taken place this may be used by the authorities to trace you.