Please tell us who you are*PatientRelative / carerMember of publicMember of staffOtherPlease specifyWhat kind of feedback are you leaving?*Information requestSuggestion / CommentConcern / ComplaintComplimentWhat is the main subject of the feedback?*Admission, discharge & transfer arrangementsAll aspects of clinical treatmentAppointments: delay / cancellationAttitude of staffCommunication / information to patientConfidentialityPatients privacy & dignityThe services involved are at*Harrogate District HospitalRipon Community HospitalSelby MIUCommunity based serviceOtherPlease specifyWho's care is your feedback about?*MyselfA family memberA friendOtherPlease specifyWould you like to be contacted by a member of the Patient Experience Team to discuss your feedback?*YesNoFull details of your feedback*Your name*Telephone number*Email address* CAPTCHANameThis field is for validation purposes and should be left unchanged.