Blank sample complaint letter

Your address
Other contact details you may wish to give,
phone, e-mail etc
Date
Name of contact person, if available
Title, if available
or Customer Services anager, if you don!t have a contact name
Company Name
Company address
"e# $service provided%
Dear $Contact &erson or Customer Service anager%,
On $date%, ' $service received etc(% at $location and other details%(
' am disappointed because $the service you provided, your service etc(% was $unsatisfactory etc((%
because $state the problem as you understand it giving as much detail as possible%(
To resolve the problem ' would li)e you to $state the action you re*uire e(g( an e+planation, an
apology, the service performed again, etc(%(
,nclosed is a copy-are copies .of any relevant documents%(
' loo) forward to hearing from you and to a resolution of this problem( &lease contact me at the above
address or by phone $give numbers%(
Yours sincerely
$Sign%
$&rint Your Name%
,nclosures# $state documents you have enclosed , if any%
Cc# $'nclude Name of person or agency you want to send a copy of this letter to%
Sample Complaint letter (1)
No( / ain Street
Carric)stown
Co( Dublin
mb0gmail(com or 123 444444
/ 5uly 41//
Customer Services anager,
St( 6ertrude7s 8ospital,
Carric)stown,
Co( Dublin
"e# Service provided in 9ccident and ,mergency Dept(
Dear Complaints Officer,
On /1 5une at :pm, ' accompanied my 2: year old father to 9-, in your hospital( 8is name is &atric)
;rown and he lives with me at the address above( 8is date of birth is / 5an /<:1(
' am very disappointed because you failed to provide a satisfactory service to him(
a= 't too) over an hour for him to be triaged(
b= >hile being triaged and afterwards he as)ed for pain relief three times but he did not receive
it until ? hours later and no e+planation was offered for the delay(
c= 9 doctor arranged for an @ray of his leg and then discharged him saying that the @ray was
negative( ;ut, as he was still in terrible pain the ne+t day, ' too) him to another hospital that
repeated the @ray, found a fracture and admitted him for surgery which he has since had(
To resolve the problem ' would li)e you to e+plain what happened on that day, why the nurses and
doctors did not do more for him and why he was not diagnosed and treated properly( ' want you to
write to him and apologise( The hospital he had his surgery in is a private one and ' have to pay for
the follow up physiotherapy( ' thin) you should arrange for free physiotherapy for him(
,nclosed is a copy of the Discharge Summary the private hospital sent his 6& so that you can see
for yourself what he was diagnosed with and what surgery he had(
' loo) forward to hearing from you and to a resolution of this problem( &lease contact me at the above
address or by phone(
Yours sincerely
olly ;rown
,nclosures# 6& discharge letter
Sample Complaint letter (2)
No( / ain Street
Carric)stown
Co( Dublin
mb0gmail(com or 123 444444
/ 5uly 41//
Customer Services anager,
St( 6ertrude7s 8ospital,
Carric)stown,
Co( Dublin
Re: Service provided in hospital
Dear Complaints Officer,
On 1 June 2008 my father !atric" #ro$n, DO# 1%1%&1, a'ove address( $as admitted to the
hospital follo$in) a turn at home* +e had 'een very dependent at home for t$o years,
re,uirin) almost 2- hour supervision from his family, due to dementia and physical disa'ility
caused 'y a stro"e* +e $as admitted to St .n)ela/s $ard $here 0 spo"e to the nursin) staff
and told them all a'out his dependency and his needs* 0 offered to stay for a fe$ hours to
settle him in 'ut they said no, they needed to assess him and they $ould loo" after him $ell*
0 am very disappointed 'ecause you failed to provide a satisfactory service to him*
a( On his first ni)ht he fell out of 'ed and 'ro"e his le) as he says no1one ans$ered his call
to help him to the toilet
'( +e $as never assisted to eat his meals and hence they $ent uneaten and he lost a lot of
$ei)ht durin) his & $ee" admission
c( 2rom 2riday afternoon until 3uesday mornin) he sa$ no doctors as it $as a 'an" holiday
$ee"end, even thou)h $e as"ed nurses on four occasions to have him seen as he $as
deterioratin)
3o resolve the pro'lem 0 $ould li"e you to fully e4plain $ho $as responsi'le for his care and
$hy the a'ove happened* 0 $ould li"e a sincere apolo)y from the hospital and staff
concerned and 0 $ant concrete evidence that the failures that occurred $ill not recur for other
patients*
0 loo" for$ard to hearin) from you and to a resolution of this pro'lem* 0 had contacted the
Om'udsman, 'ut they advised me to ta"e it up $ith you first* +o$ever, if 0 am dissatisfied
$ith your response, 0 am entitled to revert to them*
!lease contact me at the a'ove address or 'y phone*
5ours sincerely
6olly #ro$n
Here is a sample letter you may wish to use as a guide .Download te+t verion=#
Your Name
Your 9ddress
Your City, State, Aip Code
Date
6rievance Department
8ealth &lan Name
Street 9ddress
City, State, Aip Code
&olicy Number
ember-,mployee Name#
Dear Sir or adam#
The purpose of this letter is to inform you of my problem with BBBBBBBBBBB $,+plain
the problem you are having%(
y complaint concernsBBBBBBBBBBBBBB $the reason for your complaint%( 'n order to
solve my problem, ' would li)e BBBBBBBBBBBBB $the specific action you want the plan
to ta)e%(
' loo) forward to your reply and a resolution of my complaint(
Sincerely,
Your Name