Customer Relations - Birmingham and Solihull Mental Health NHS Foundation Trust

Customer Relations form

Name of enquirer(Required)

Name of patient (if not the enquirer)

Patient Rio or NHS number* (Type ‘Unknown’ as an option if not known)(Required)

Enquirer’s address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Patient’s address(Required)

Same as enquirer

Patient's address

Street Address Address Line 2 City ZIP / Postal Code

Patient’s date of birth(Required)

Please select how you would prefer to be contacted:(Required)

Post

Phone call

Written feedback may need to be provided with some cases

Email(Required)

Phone(Required)

Postal Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

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Preferred contact day

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred contact time

Summary of experience(Required)

Desired outcomes(Required)

Any other information

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Unique Reference

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Our Sites

Our Trust has over 40 sites that range from teams in your local community, through to inpatient hospitals and residential settings.

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The Trust uses a number of privacy policies, to access them visit our polices page

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