Get Klachtenformulier

Filing a complaint is an essential process when you are dissatisfied with services received. The Klachtenformulier allows you to formally express your concerns. This guide will walk you through each section of the form to ensure your feedback is communicated clearly.

Follow the steps to successfully complete the Klachtenformulier.

1. Press the ‘Get Form’ button to access the Klachtenformulier and open it in your preferred editing tool.
2. Begin by filling in the personal details of the person involved in the issue. Include their name in the designated field.
3. Indicate the gender of the patient by selecting one of the options provided: 'man' or 'vrouw'.
4. Provide the patient's address, including street, postal code, and city accurately in the corresponding fields.
5. Enter the patient's date of birth in the specified format.
6. If applicable, include the patient's identification number in the designated space.
7. Fill out the phone number where the patient can be reached during the day.
8. Sign the form in the area provided to validate the submission.
9. If the complaint is submitted by someone other than the patient, select the appropriate option and provide that person's details, including their name, address, and relationship to the patient.
10. Record the date the complaint is submitted in the allocated field.
11. Include information about the involved parties, such as their names and departments, along with the date when the incident occurred.
12. Indicate whether the complaint has already been discussed with the involved party by selecting 'ja' or 'nee'.
13. In the 'Omschrijving klacht' section, detail the nature of your complaint clearly and precisely.
14. After completing the form, review all entries for accuracy. Save any changes, and download or print the form if needed.
15. Send the signed form to the address provided for Klachtenbehandeling LUMC to proceed with the complaint process.

Start completing your Klachtenformulier online today to ensure your concerns are addressed.