Northpoint Complaint form

Complaint form
We're sorry that you're unhappy with your experience of our services.

Please complete this form, being as specific and detailed as you can, to help us help you.

You'll receive an immediate auto-response email, which will give you a copy of your complaint and the information below about what to expect next.

We'll then write to you with the results of our initial investigation within 10 working days.
Your details
Please put your own name and email address here, even if you're completing the form on behalf of someone else - including if you're a Northpoint member of staff.
Your name*
First & last name
Your email address*
For our response, and for a copy of this complaint
Are you contacting us as a professional (including Northpoint staff completing this form on behalf of a client/carer)?*

YesNo
Do you work for Northpoint?*

YesNo
Your role/job title*
Your service/team*
Name of complainant (on whose behalf you're completing this form)*
First & last name
Hidden 'pp' marker for submissions made by Northpoint staff on behalf of complainant
When was this complaint first received by Northpoint? - either verbally or in writing, and whether via practitioner, manager or other staff*

DayMonthYear
How was this complaint received?*
Which mailbox was the complaint sent to?*
Which location was the complaint sent to?*
Please forward the original email to riskandcompliance@northpoint.org.uk, as well as submitting this form.
Please scan the letter to riskandcompliance@northpoint.org.uk, as well as submitting this form.
Please give any other key details about how/when the complaint was received (but not the content of it - see below)*
[HIDDEN: was general question re how/when the complaint was received - OLD - no longer used]
If you have not got all the information requested on this form, please just fill it in as best you can from the information you have (e.g. put 'not known', 'not stated', etc), and we will follow up as required.
Role*
Organisation or base*
Phone number*
Your phone number
This is helpful too, if possible
Service user details

This may be you, another adult, or a child/young person.
Who does your complaint relate to?*

YourselfAnother adultA child or young person
This person's name*
Child or young person's name*
Your relationship to them*
Their date of birth*
DD/MM/YYYY
Their school*
Your GP practice (if applicable)
If you've been seen through your GP by our Healthy Minds Practitioners or Mental Health and Wellbeing Advisors
Their GP practice (if applicable)
If they've been seen through their GP by our Healthy Minds Practitioners or Mental Health and Wellbeing Advisors
Service user details

Please give as much detail as possible to help us identify the client.
Name*
First & last name
Date of birth (if known)
DD/MM/YYYY
School (if applicable)
GP practice (if applicable)
If they've been seen through their GP by our Healthy Minds Practitioners or Mental Health and Wellbeing Advisors
Service details

Please give us any information you can, to help us direct your complaint to the right place.
Which Northpoint service/s does your complaint relate to? (tick any that apply)*

Calderdale Mental Health Support Team (MHST)Calderdale Open Minds (CAMHS)Children's Centre Counselling ServiceDistrict 29 Therapeutic CommunityGP-based services (Healthy Minds Practitioners / Mental Health and Wellbeing Advisors)Leeds Mental Wellbeing Service (LMWS)Mondays @ NorthpointSchool Therapy ServicesNot sure? - please add anything you can about the type or location of service
Name/s of any Northpoint staff involved (if known)
Their job title or role (if known)
Your complaint
Your complaint relates to:*
This complaint relates mainly to (tick any that apply):*

Length of waitQuality of serviceInformation or communicationVenueOther - please explain below
Tell us about your complaint - please be as specific and detailed as you can, to help us help you.*
Thank you

We appreciate you taking the time to contact us.

You'll receive an auto-response email, which will give you a copy of your complaint and the information below about what to expect next.

We'll then write to you with the results of our initial investigation within 10 working days.
Should be Empty:

Complaint form

Your details

Service user details

Service user details

Service details

Your complaint