Your complaint about CZ We appreciate you taking the time to make your complaint known to us; we can learn a lot from it. We will call you as soon as possible to discuss your complaint. This form contains errors. Check the fields and send again. Please explain your complaint as clearly as possible Is your complaint in response to a letter you received or a telephone conversation? in response to a letter in response to a telephone conversation no What is the reference number on the letter? (not required) What is the date of the letter? (not required) Day Month Year Do you know who you talked to? (not required) When did you call us? (not required) Day Month Year Personal details Title Mr Ms First name and surname Do you have your CZ customer number at hand? yes no CZ customer number Your customer number is displayed on your CZ healthcare card or policy Date of birth Day Month Year Postal code House number and possible suffix Email address We will send a confirmation and a copy of the filled out data to this email address Telephone number We would like to discuss your complaint with you directly, and to do this we would like to call you.