Feedback and complaints form Notice Please use the below form to submit any comments regarding Beechwood Medical Practice, based in Bristol. Full name (optional) Address Date of birth Contact number (optional) Email address (optional) Date of visit (if applicable) Feedback Please provide your feedback in one or two sentences. Please include dates, times and names of individuals involved (if known). Can you identify why the issue may have arisen? For example – did this happen as a result of a communication problem, a personality conflict, conflicting information. Are you looking for a specific outcome from this complaint? Common outcomes that help us improve our service include: training, improving communication, looking at ways to work differently or by simply apologising where your experience has not been as you had wished.