Client Feedback & Complaints Form

Client Feedback Form
Anonymity

I am making this feedback/ complaint anonymously. Please note that if you are making your complaint anonymously we may be unable to respond to your complaint and let you know what is happening.
Client Details
Name*

First NameLast Name
Phone Number*
Email address*
example@example.com
Postal Address*

Street Address

CityState / Province

Postal / Zip Code
Representative

Fill in this section if someone is assisting you to complete this form. Please note that by listing a representative, you are giving Quad Care Pty Ltd authority to liaise with this representative on your behalf.
Name of Representative

First NameLast Name
Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organisation
Phone Number
Email address
example@example.com
Details of complaint/feedback
Date the problem or concern arose

DayMonthYear
Date
Who was involved?
Please provide as many details as possible to help us understand your concerns. You can include what happened, where it happened and who was involved or the decision you are unhappy about. OR Please let us know what feedback you would like to provide us.*
What outcome(s) are you seeking? Do you want us to change anything in the future?*
How would you like us to let you know about the progress of your complaint/feedback?
To me

In personBy phoneBy emailBy mail
To my representative

In personBy phoneBy emailBy mail
Please attach any supporting information

Cancelof
You can also give feedback to the NDIS Commission: They take feedback or complaints about services that you are not happy with.

You can call them on: 1800 035 544.

Or you can call the National Relay Service and ask for 1800 035 544.

You can also do this online here: https://www.ndiscommission.gov.au/participants/complaints.

You can also call the NDIA on 1800 800 110.

You may seek support from family, a friend or an independent advocate when making a complaint. For further information about disability advocacy please visit the NDIS Commission website.
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Client Feedback Form

Client Details

Representative

Details of complaint/feedback

How would you like us to let you know about the progress of your complaint/feedback?