Lodge a complaint

Please fill in the form with as much detail as possible. The information you provide will assist MCM in processing your complaint effectively.

Name *

Phone Number

Email Address (if available)

Postal Address (optional)

there (optional) If

Date of Incident

Time of Incident (if known)

Location / Health Facility Name

Name(s) of Practitioner(s) Involved

(Practitioner 1)

Practitioner 2 (if any)

Please describe what happened? (provide as much detail as possible)

(Include what happened, how, when, and the outcome)

Were there any witnesses

• Yes
• No

If yes, provide their names and contact (if available)

Have you raised this issue with the facility before?

• Yes
• No

If yes, what was the response or outcome?

Submit