COMPLIMENTS AND COMPLAINTS Please complete the below form should you wish to lodge a formalcompliment or complaint. Is this a compliment or complaint: ComplimentComplaint Details of other person or doctor involved in this complaint/compliment: Date of Incident: Description of compliment or complaint: I give permission that my personal details be shared with the involved parties I hereby consent to the personal information provided by me to be used for delivery of services offered by Geneway™. It is my legal obligation to provide correct information in the contracting with Geneway™ and where such information has been changed, I am obliged to inform Geneway™ accordingly. I am aware that I can unsubscribe to any newsletters, campaigns, communications from Geneway™ by notifying them accordingly. It is my right to request Geneway™ to delete and cease to use any of my personal information subject to any legal obligation on Geneway™’s side to keep same. There is a legal obligation for Geneway™ to retain your information for 5-years from date of contracting, whereafter it will be destroyed in a POPIA compliant manner. Should I believe that there has been a misuse of my personal information, I am aware that I can lodge a complaint with Geneway™ and / or the Information Regulator at firstname.lastname@example.org I hereby acknowledge that I understand and agree to the above mentioned statements. Please leave this field empty.