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
Date

DayMonthYear
Date
Time

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Hospital Location / Ward / Health Centre / Clinic / Other:
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FILLING IN THIS SECTION will enable us to reply if necessary. Or provide feedback.
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Name

First NameLast Name
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Quality and Business Improvement Lead

Hokianga Health, Private Bag 753, Kaikohe 0440. Phone: (09) 405 7709 ext 361
Should be Empty:

Suggestions, Compliments and Complaints