Complaints, Compliments and Feedback

Suggestions, Compliments and Complaints
We welcome and appreciate receiving your feedback.

Filling in this form will not adversely affect the quality of care you receive from Hauora Hokianga either now or in the future. Everything you say will be treated CONFIDENTIALLY.

Thank you for your time in letting us know how you feel.
Feedback Type*

ComplimentSuggestionComplaint
Date

DayMonthYear
Date
Time

:HourMinutesAM/PM Option
Hospital Location / Ward / Health Centre / Clinic / Other:
Please provide Details*
FILLING IN THIS SECTION will enable us to reply if necessary. Or provide feedback.
Select the options that you would like to proceed with (if any)

If you would like your name passed on to staffwith any commentsIf you would like your comments passed on tostaff without your nameIf you would like us to treat this as a formal complaint
Name

First NameLast Name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
QUALITY AND COMPLIANCE CO-ORDINATOR

Hokianga Health, Private Bag 753, Kaikohe 0440. Phone: (09)4057 709 ext. 827
Should be Empty:

Suggestions, Compliments and Complaints