COMPLIMENT AND COMPLAINT FORM

Thank you for taking the time to complete this feedback sheet. We will use your comments to improve our business. This is a confidential document, and names are not required. An effective feedback, compliment and complaint handling system addresses the principles of visibility and accessibility, responsiveness, assessment and investigation, feedback, improvement focussed and service excellence. Our service is committed to providing high quality care and services and meeting your needs. We value your feedback – including complaints. Please let us know what we do well and where we can improve our services.

This is A: (indicate your responce by ticking a box below)

ComplimentComplaintFeedback

Permalink Support Services values customer feedback and is committed to responding to all feedback in a timely manner. Feedback may include:

Compliments

These are things that you think we’re doing well or may be recognition of a person who provides a service to you. By telling us what you like, we can aim to continue to do these things and provide feedback to staff.

Suggestions

Your ideas on how we can improve things or do things better can help us to improve our services.

Complaints

We want to know when you’re not happy about an experience you’ve had with Permalink. A complaint can be about a person, a service or something you have experienced.
If we need to contact you, it’ll be from a private number. For privacy reasons, we can’t leave a message. Unless your voicemail clearly identifies who you are.

What we need from you

Please be clear, factual, and tell us the outcome you would like. Providing your name and contact details will also help us to get in touch and help resolve the issue. If you provide feedback anonymously, we won’t be able to respond to you personally.

How we’ll respond

We aim to resolve complaints within 10 working days. If we can’t resolve your complaint, we will explain why and let you know what other options you have. If the matter is urgent, please email support@permalink.com.au or contact us on 03 9084 7494, option 2 to speak to management.

Do you want to remain anonymous?

YesNo

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Mobile Number

Please enter a valid phone number.

Email

example@example.com

Do you require an interpreter?*

YesNo

If yes, which language?

What is your relationship to Permalink? Please select all statements that apply

I am a person with a disability, and I receive services from PermalinkI am a person with a disability, but I do not receive services from PermalinkI am Care team member of a person with a disability who receives services fromI am a family member of a person with a disability who receives services fromI am a friend of a person with a disability who receives services from PermalinkI am a Permalink staff memberI work for a government body, am an advocate or work for an advocacy organisationOther

Please state your feedback/concern.

Please provide details of your feedback/concerns, including what events led to making the complaint, compliment or feedback, approximate dates and who was involved.

What action have you already taken in relation to this feedback? Have you discussed with Permalink Support Services’ Client Service Manager, your support coordinator, NDIS or any other agency or person for assistance with these concerns?

YesNo

If yes, with whom and what was the outcome?

What outcomes would you like as a result of providing your feedback?

What other improvement do you suggest for our organisation?

Permalink Support Services is committed to protecting your privacy. We collect and handle personal information that you provide on this feedback form for the purpose of investigating and responding.

Permalink Support Services will only use your information in accordance with relevant privacy and other laws. For us to provide services to you effectively and efficiently, we may need to share your personal information with others, such as NDIA that deals with the matters identified in your feedback.

If you choose to remain anonymous, Permalink Support Services may be unable to deliver the full range of services you require.

If you wish to contact Permalink Support Services who are responsible for managing the personal information that you provide on this form, please get in touch with us:

Visit Us: 164 Rosebank Avenue, Clayton South VIC 3169

Call Us: 03 9084 7494, option 2

Email Us: support@permalink.com.au |

Declaration

Date

Other agencies that can help with a complaint:

National Disability Insurance Agency

Disability Services Commissioner

Telephone: 1800 677 342 (free call) TTY service for people with hearing or speech difficulties: Telephone: 1300 726 563

Email: complaints@odsc.vic.gov.au

Department of Education and Training

Email: complaints@education.gov.au

Department of Families, Fairness and Housing

Email: feedback@dffh.vic.gov.au

Website: www.publicadvocate.vic.gov.au

VACCHO(Victorian Aboriginal Community Controlled Health Organisation Inc

Email: enquiries@vaccho.org.au