Feedback and Complaint Form

Feedback and Complaint Form
Thank you for taking the time to let us know how we are doing.

Our Commitment

We are dedicated to providing safe, quality services. We welcome your feedback to help us keep improving.

How we handle feedback:
- All feedback is acknowledged and responded to.
- You will receive a response within 48 hours.
- Positive feedback will be celebrated with staff and programs.
- We investigate and resolve complaints promptly and fairly.
- Complaints are confidential and help us improve our services.
If you need help completing this form or require an interpreter or advocate, please contact:

Nicole Leathem, Chief Operations Officer
Phone: 0438 752 126
Email: nicole@extendedfamilies.org.au

Contact us for a full copy of our complaints policy.
Date

DayMonthYear
Date
Would you like to remain anonymous?

YesNo
Your name

First NameLast Name
Your phone number
Your email address
example@example.com
Are you providing this feedback, complaint or a suggestion on behalf of someone else?

YesNo
What is your relationship to the person you are providing the feedback, complaint or suggestion for?
Would this person prefer to remain anonymous?

YesNo
Name of person receiving our services.

First NameLast Name
Phone number
Email address (if relevant)
example@example.com
Does this person know you are providing this feedback?

YesNo
Does this person agree to us contacting them in response to this feedback?

YesNoUnsure
Type of feedback

About a service receivedAbout a specific incidentA decision we madeAbout how we do things (processes)Positive feedback about staffAbout a staff member or volunteerIdea to make things betterOther
Date of incident (if relevant)

DayMonthYear
Date
Does your feedback relate to a specific person or service? If yes, please tell us who or what service.
Please provide name and relationship to the organisation
Please describe your feedback. Tell us what happened, who was involved, where and when.
What would you like to happen as a result of your feedback?
Have you told anyone about this before?

YesNo
Please provide details
Thank you for taking the time to share your feedback.

We will be in contact with you within 2 business days.
Should be Empty: