Complaints/Compliment Form

Full Name*

First NameLast Name

I wish to lodge a*

Are you doing this on behalf of yourself?*

If you have selected no, please complete the box below. Please note that patient confidentiality is extremely important to us and therefore there may be some information that we cannot share with you without the correct permissions.

The details of the person whose behalf you are doing this on and your relation to them

Date of relevance

Please provide more details about your complaint or compliment below**

*We ask that you are as detailed as possible

Please provide feedback on how we can further improve your experience

Would you like a member of our Practice Team to contact you about this?*

Our standard for responses to complaints is 21 days to allow the relevant clinician or administration staff to put forward their understanding of the situation.

If yes, please provide your email address below

Please note that if you do not provide the correct email address, we will be unable to contact you.

By completing this form you are consenting to Phoenix Mental Health Services/Allen Associates processing and storing your personal data. More information on how we store complaints and compliments can be found on our Complaints Policy (a copy of this can be requested by emailing enquiries@phoenix-mhs.com). We will only use the data provided for the purposes of handling this complaint or compliment (if appropriate). You have the right at any time to ask for your data to be deleted. For complaints, if this is requested prior to us responding to you, it may affect the way in which we manage it.

Complaint/Compliment Form: