Feedback, Compliments and Complaints Form

Feedback, Compliments and Complaints Form
Fill in the details of the person who is providing feedback, compliment or complaint (if you wish to remain anonymous do not fill out the personal details)
Name of person

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
If you are providing the feedback, compliment or complaint on behalf of another person please provide the following details
Your name

First NameLast Name
What is your relationship to the person?
Does the person know you are making this compliment/complaint/feedback?
Does the person consent to the compliment/complaint/feedback being made?
Who is the person, or service about whom you are providing feedback about?
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
What is your compliment/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 send us copies of any documentation that may help us to investigate your complaint/feedback (for example letters, references, emails).
What outcomes are you seeking as a result of the compliment/complaint/feedback?
Feedback Survey

Type a question

	Always	Most of the time	Some of the time	Not at all	Not sure
Is the service we provide meeting you needs?
Do you have a better understanding of what services and supports are available to you? e.g. accommodation, community participation, SDA
Do you feel you have choice and control when using our services?
Do you feel supported to set and work towards achieving your own goals?
Do you feel as though you have a better understanding of the NDIS processes since working with Thrive@Life
Would you recommend or refer us again?

Fill in the details of the person who is providing feedback, compliment or complaint (if you wish to remain anonymous do not fill out the personal details)