Concerns Form

  • The concern
  • Your details
  • Reporting concerns on behalf of others
  • Attach evidence and documentation
  • Summary

The concern

Are you reporting this concern as: (required)
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Are you an employee who is reporting a concern about your employer? (required)
Do you have any specific communication needs? (required)
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Include details of anything we might be able to do that will make it easier for you to deal with us. We will consider all reasonable suggestions. If you have question or difficulties with filling in the form, please call us on 020 3713 8000.

What is the concern about? (required)
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Do you know the name of the pharmacy professional involved? (required)

A pharmacy professional is a pharmacist or a pharmacy technician who is registered with the GPhC. To check whether a professional is registered with us, you can check our register
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You will be asked for more details when you select this option
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This is the seven-digit number which shows that a pharmacy professional is on our register.

Please give us as much information as you can that might help us identify the pharmacy professional. For instance, do you know their name or part of their name? What did they look like?

Please provide the name and address of the pharmacy. Please use our register (opens on a separate window) to find the full details of the pharmacy.

Please describe the incident(s) that have led you to report a concern

Please explain:

  • what happened
  • how it affected you
  • if it was one incident, or several incidents over a length of time relating to the same concern.

Please include any relevant information, such as the name of any medication involved. Please also give details of any evidence you have to support your concern, for example: ‘I have an apology letter from the pharmacy and a photograph of the incorrect medication they gave me’. You will be able to submit those pieces of evidence later on in the ‘Attach evidence and documentation’ section of this form. Please make sure you keep copies of all paper or electronic of documents as we may need to see them as part of our investigation.

When did this incident take place?

Please use the fields below to let us know the incident took place. If you are unsure of the exact date, you can just provide details of the month and year.

The date the incident took place (month and year required)

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Did anyone else see or hear the incident? (optional)
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Have you contacted anyone else about the concern? (required)
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Who else have you contacted about your concern? (required)

Please select all of the options that apply
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More information about the MHRA

The MHRA regulates all medicines and medical devices in the UK. We may contact them to discuss the concern if it relates to an adverse reaction to a medicine or medical device.

Please provide the contact details of other organisations or individuals that you have contacted about the concern. We many need to get in touch with them to find out more about the concern.

Is this person aware that you are giving their details to the GPhC and that we may contact them? (required)