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Data Protection Complaints Request Form

If you have concerns about how your personal information has been used, you can raise a data protection complaint using this form.

We will investigate your concern in accordance with our Data Protection Complaints process.

This form relates to data protection complaints only. If your concern relates to care or treatment, please contact our Customer Care team at ecn-tr.CustomerCareService@nhs.net or telephone 01625 661449.

Section 1: Your details

Required
Required
Required
Required
Required

Section 2: Proof of Identity

Please provide copies of two official documents which between them provide sufficient information to confirm your name, address and date of birth.

 

Required
Required
Required

Section 3: Making the Complaint on behalf of someone else

If you are making the complaint on behalf of someone else, please state which of the following applies:

  1. I have been asked by the individual to make the complaint and have written authorisation.
  2. There is a Lasting Power of Attorney for Health and Welfare and I am entitled to act on the individual’s behalf.
  3. Other – please give details.

Please attach a photograph or scanned image of the documentation. 

Required

Section 4: Details of Concern

Required
Required

Section 5: Declaration:

I confirm that the information I have provided is accurate.

I understand that my information will be used to investigate my complaint.

Required
Required
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