Our Health Complaints Advocacy service is for anyone in Leeds who needs help to make a complaint about a local NHS service. This is free to use and you can self-refer. To make a referral, please complete the form below.

    Health Complaints Advocacy Referral

    1. Details of the person requiring advocacy


    2. Complaint Details



    3. Reason for advocacy referral? (Please include a summary of the advocacy issue/decision being made, upcoming meeting dates, deadlines, priority areas etc.)

    4. Referrer details (only fill this in if you are not the person who requires advocacy)

    5. Risk Issues


    6. Other relevant information about the person requiring advocacy

    YesNoDon't KnowPrefer not to say

    Acquired brain injuryAutistic Spectrum ConditionBlind/partially sightedCarerCognitive impairmentDeafDementiaLearning disabilityLong-term health conditionMental health needsOlder person (frailty)Physical condition/illness

    Word Referral Form

    If you are having issues with our online referral form, we have a version of it in Microsoft Word. To make a referral this way, please download the document by clicking on the button below, complete it and email it to [email protected]. Please also get in touch if you have any questions about the referral form.