NMBI - Customer feedback: NMBI

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Registered nurse or midwifeMember of the publicOther

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RegistrationFitness to PractiseEducationFinanceCareer Information (Nurses / Midwives)Other

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CommentComplimentComplaint

4. Do you require a formal response?:

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5. If making a complaint, is this the first time you have complained about this issue?:

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6. If ‘no’, please provide details of your previous complaint :

7. What was the date of the event or issue giving rise to the comment, compliment or complaint?:

8. Please give full details of the experience giving rise to the comment, compliment or complaint:

Customer Feedback

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1. Personal details
Surname*:
First name*:
I am a*:	Registered nurse or midwifeMember of the publicOther


Address:
Email*:
Mobile phone number:
Home phone number:
2. What does your feedback relate to?*
RegistrationFitness to PractiseEducationFinanceCareer Information (Nurses / Midwives)Other

3. Are you making a*:	CommentComplimentComplaint
4. Do you require a formal response?:	YesNo
5. If making a complaint, is this the first time you have complained about this issue?:	YesNo
6. If ‘no’, please provide details of your previous complaint :
7. What was the date of the event or issue giving rise to the comment, compliment or complaint?:	Date and time
8. Please give full details of the experience giving rise to the comment, compliment or complaint: