UK GDPR

Data Protection Complaint Form

Please use this form if you have a concern or complaint about how I have collected, stored, used, or deleted your personal or clinical data under UK GDPR and the Data Protection Act.

1. Your Details

Full NameEmail AddressPhone NumberPostal Address

2. Are you complaining on behalf of someone else?

No (It is about my own data)Yes (Please provide the data subject's details and proof of authority/written consent below)

3. What is your complaint about? (Tick all that apply)

Delay or refusal regarding a Subject Access Request (SAR / Access to notes)Information shared incorrectly or without authorizationInaccurate clinical or personal recordsData security concern / potential breachInformation retained longer than necessaryOther

4. Details of Your Complaint

Please describe what happened, including relevant dates and the specific impact this has had on you. If you have screenshots, please email them to me.

5. Desired Outcome

What would you like for me to do to put things right?

6. Declaration & Signature

Signature (type your full name)Date

Next Steps & Practice Obligations

Acknowledgment: As a data controller, I will acknowledge receipt of your complaint in writing within 30 days.
Investigation: I will investigate your concerns thoroughly and aim to provide a full outcome response without undue delay.
Escalation: If you remain unsatisfied with my final response, you have the right to contact the Information Commissioner's Office — ico.org.uk.