CONTACT FORM

This contact form has been created to allow for patients and their representatives to formally address any issues that may require contact with the treating Brink anaesthesiologist. The intention is to allow for a constructive interaction that results in a satisfactory result for all parties.

The procedure for submitting this form is:

1. Please go to the Brink Inc. website: www.brink-inc.co.za.
2. Click on the Contact Form link.
3. Complete the form.
4. Submit the form.
5. Once submitted, you will receive confirmation of receipt by e-mail that your form has been received within one working day.
6. Your contact form will be comprehensively reviewed and responded to within 5 working days by the treating Brink anaesthesiologist.

In the event of a complaint, should you not be entirely satisfied with the result of your interaction with the anaesthesiologist post processing of your complaint, in accordance with the consent agreement provided pre-operatively, the complaint may be further pursued as follows.

1. Complaints can then be forwarded to the South African Society of Anaesthesiologist (SASA) at ceo@sasaweb.com. (Website: www.sasaweb.com)

2. Should the processes of SASA not resolve your complaint, your complaint may be forwarded to the Ombudsman of the Health Professions Council of South Africa (HPCSA). Should your complaint continue to be unresolved, the Ombudsman will advise on how to pursue the complaint further.

Details of person completing this form