Complaints and Feedback Form

Complaints & Feedback Form

Would you like to make this feedback/complaint anonymously

Yes

Please note that if you are making your complaint anonymously, we may be unable to respond to your complaint and inform you about our actions.

Fill in the details of the person who is making the complaint/providing feedback.

Full name

Address

Phone

Preferred contact method

If you are making the complaint/feedback on behalf of another person provide the following details.

Their full name

What is your relationship to the person?

Does the person know you are making this complaint/providing feedback?

Yes

Does the person consent to the complaint/feedback being made?

Yes

Preferred contact method

Who is the person, or the service about whom you are complaining or providing feedback about?

Their name

Contact details (if known)

What is your Complaint/Feedback about?

Provide some details to help us understand your concerns. You should include what happened, where it happened, time it happened and who was involved.

Supporting Information

Please attach copies of any documentation that may help us to investigate your complaint/feedback (for example letters, references, emails).

What outcomes are you seeking as a result of the complaint/feedback?