Complaints form

Make a complaint

Please make sure you provide below an email address or phone number (or both) so we are able to reply as we are unable to reply directly to these submission forms. We will acknowledge your complaint or feedback within three working days and provide more information about the complaints process. You can also contact us on 020 3069 0240 or [email protected]. Please contact us via the above details if you have any issues navigating this form. If you are an LAS member of staff, please do not complete this form. Please use Datix.

Incident date - if applicable
DD slash MM slash YYYY

If you do not the exact date please add a rough estimate.
Title * REQUIRED
If other, please tell us your preferred pronoun:
First name
First
Last name
Last
Phone
Email * REQUIRED
Patient's name (if different)
First Last
Please fill in this box if the complaint relates to patient care. Please leave empty if this complaint does not relate to care of a patient.
Patient's date of birth
DD slash MM slash YYYY
Address (if known) of incident or location
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Your relationship to the patient
Details of your complaint * REQUIRED
Equalities Monitoring information
The London Ambulance Service is committed to promoting equal opportunities across everything we do. The information you provide on the fields below will enable us to check that we are fulfilling our duties under the law, to the NHS and to our communities, and help us to improve the quality of service for all users. It will also help us to improve the quality of service to all our service users. This information will remain anonymous and will be used for monitoring and compliance purposes only in line with the Data Protection Act 2018 and UK GDPR. We would be very grateful if you could take a little time to complete this form. If you have any questions about the form, please contact the Patient Experience team on 020 3069 0240 or email: [email protected]
What best describes your gender?
If you prefer to use your own gender identity, please write in:
Is the gender you identify with the same as the sex assigned at birth?
What is your age group?
What is your ethnicity?
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please select the appropriate box.
Any other ethnic group, please write in:
Do you consider yourself to have a disability or long term medical health condition?
What is your sexual orientation?
If you prefer to use your own sexual orientation identity, please write in:
What is your religion or belief?
If other religion or belief, please write in:
Do you have caring responsibilities?
If yes to the previous question, please tick all that apply:

Information about the way that we use the data that you provide can be found in our privacy policy.

Complaints form

Make a complaint

Equalities Monitoring information