IHCA Referral form



1 Start 2 Complete
Details of person being referred
Address and postcode at time of referral (if different from home address)
Demographic information about the person being referred
Details of the complaint

Per NHS regulations, if you have already received a final response, you will not be eligible to be supported by the Independent Health Complaints Advocacy service)

What support you need

Per the NHS regulations, this is unlikely to be something the IHCA service can help you with.

Your IHCA will not be able to instigate any disciplinary procedures against a member of staff as this decision is made by the organisation. You may be able to contact General Medical Council (GMC), General Dental Council (GDC) l, Nursing & Midwifery Council (NMC) to raise your concern)

If you are a professional referring an individual to our IHCA service, please provide your contact details below
By completing this form you agree to Gaddum keeping this information stored on a secure electronic case recording system, computer, and paper filing system. You confirm you are providing this information and asking for this referral in the client’s best interests. You are confirming wherein the client has capacity to do so, you have sought consent for this referral.