Filing a complaint

You can submit your complaint by using the complaint form below or by downloading the form below. You can mail the completed form to klachten@mildredclinics.nl. You can also send it by mail. The address is:

Mildred Clinics
Attn: complaints officer
Sonsbeeksingel 29
6814 AB Arnhem

Filing a complaint online

Complainant

Name(Required)

Initials(Required)

Date of birth(Required)

Home address(Required)

Postal code(Required)

Residence(Required)

Phone number(Required)

Email address(Required)

Representative/supporter

(complete only if applicable) >

Name

Initials

Home address

Postal code

Residence

Email address

Complaint

I authorize the above representative to file a complaint on my behalf

Agreed

Location

Date

What/whom¹ does the complaint relate to (fill in only what is applicable) >

Name

Function

Clinic

Arnhem

Eindhoven

Below you can describe your complaint(Required)

I do/do not¹ give permission to access my file for the purpose of complaint handling(Required)

I do authorize access to my file for the purpose of complaint handling

I do not authorize access to my file for the purpose of complaint handling

Location

Date

I would like to be contacted in the following manner

Phone

By mail

If you would like assistance in drafting your complaint, please contact the complaints officer at klachten@mildredclinics.nl >