Complaint Form

If you are dissatisfied with the quality of the disability services or supports provided by us, we encourage you to make a formal complaint. Your input is essential in helping us address any concerns and improve our services to better meet your needs. Please take a moment to answer the following questions to initiate the formal complaint process:

Please tell us about yourself:

Name

Phone

Email

example@example.com

How would you like us to contact you?

PhoneEmailOtherI do not want to be contacted

Do you want us to keep your name and complaint private?

You can share my complaint and my name with the support worker/coordinatorYou can share details of my complaint, but I want my name kept privateYou can share my complaint, name or my information with the support worker/coordinatorI do not know.

Type a question

The person receiving supportsA staff memberOther disability or health professionalA friend or relative of the person receiving supportA member of the pub

If you re making this complaint on behalf of someone else, is the person who received the support aware that you are making a complaint on their behalf?

YesNo

If no, is there a reason why the person is not aware of this complaint?

Who are you complaint about? Name of staff:

Have you complained about this to anyone else?

YesNo

Who else have you talked about your complaint?

Provide some details to help us understand your concerns. You can include what happened, when it happened and who was involved, or the decision made by the coordinator that you are unhappy about.

How can we help you make your situation better?

Thank you for taking the time to provide feedback to Supported Lifestyle Services. Email the completed form to complaints@supportedlifestyleservices.co.nz

Ifyou have asked us to contact you, we will aim to be in touch within five working days.

If you want to contact us again, please see Supported Lifestyle Services contact information below

Email info@supportedlifestyleservices.co.nz Address L1/97Grey Street Palmerston North Central Palmerston North 4410

Complaint Form

COMPLAINT FORM