Feedback

Do you want to share something with us? It can be a tip or a compliment, but also a complaint.

Choose either Compliment or Complaint below to access the appropriate form. You can also indicate whether you expect a response from us — we always respond to submitted complaints.

Compliment or tip

How nice that you want to give us a compliment and/or tip. We’ll make sure your compliment and/or tip reaches the right person.

Complaint

It may happen that you are not satisfied with our services. Unfortunately, that’s a pity! Through this form, you can submit a complaint. We will ensure that your complaint reaches the right person and that action is taken.

Name of Submitter

Man / Woman

Address

Zipcode

Place of residence

Phone number

Name patient

Date of birth

Relationship between the submitter and the patient

Date of the incident

Time

The complaint is about (multiple choices possible) The complaint is about (multiple choices possible) Medical treatment by staff Behavior of the staff (how the staff interacts with you) Organization (how things are organized) Administration or finances Differtent

Description of the complaint

8 + 9 =

Contact

0172 – 249 001

Opening hours

ma-vr 08:00-17:00 uur

Sterrenlaan 110A

2402 BA Alphen ad Rijn