* Required Field   

Your Details

I am
     
Title*
Forename*
Surname*
Date Of Birth*
Email:
Address*
Postcode*
Home Phone:
Mobile Phone:
Describe your complaint
(please state clearly what
happened and when,
details of your discussions
with the practice and
what in particular you are
unhappy with)
How would you like your
complaint resolved?:
Have you complained in
writing to the practice?
If yes, please send us copies
of all correspondance.
Where you hear
about the VCMS

Animal Details

Type
Breed
Name
Gender
Age
Is The Animal Alive?

Practice Details

Practice Name*
Address
Postcode
Phone:
Website:
Email:
If your complaint relates to a particular vet, please provide the name:
Practitioner Title
Practitioner Forename
Practitioner Surname

Equality & Diversity

Age
Gender
Disability
Ethnicity
Sexual Orintation
Marital Status
Religion
Region
Country

Contact

The VCMS will review the information provided and will contact you within the next 5 working days. How would you like us to contact you?
Contact

Declaration

Please read the terms below and click I agree. We will not be able to assist you if you do not agree to all of the statements.

  • To the best of my knowledge everything I have reported to you is correct
  • The Veterinary Client Mediation Service may also discuss the circumstances of my complaint, animal care and client services with the veterinary practice, their representatives, the Royal College of Veterinary Surgeons, and relevant third parties such as other veterinary practices that were involved in the care of my animal
  • I will treat any information provided to me by VCMS as confidential and will not pass this on to anyone else
  • I will cooperate fully with VCMS during their involvement with my complaint
I Agree*