Complaint, Compliment & Feedback Form

Anonymous Complaint, Compliment & Feedback

If you would like to be anonymous with your complaint/compliment/feedback please tick the box and go to Question 3.

1. Please provide your contact details for the complaint/complement/feeback

Name of Person

Address

Email^*

Contact Number

My preferred contact method is

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

Their Name

What is your relationship with the person?

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

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

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

The Name of the person this is about^*

Their Contact Details (if known)

4. What is your Complaint/Compliment/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.

Details

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

Summarise the outcome

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Friday	8:00AM ‑ 3:00PM