Complaints / Feedback Form

1. Complete this form

2. The Complaint Manager will contact you upon receipt of this form.

   Note: You can send in the Anonymous Complaints and Feedback form in the stamped self-addressed envelope that you received at intake.

Name of Person

Address

Phone

Email

My preferred contact method is

Your Name:

What is your relationship to the person?

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

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

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 because of the complaint/feedback?