Complaints Form

Complaints Form

Avia Aide - Disability Services
Fill in the details of the person who is making the complaint.
Name Of Person

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Preferred Contact Method

Phone / MobileEmail
I Am Making This Complaint Anonymously
YesNo
1. Please Note: That if you are making your complaint anonymously, we may be unable to respond to your complaint and inform you about our actions.

2. Leave the personal information sections blank if submitting a complaint anonymously.
If you are making this complaint on behalf of another person provide the following details.
Your Name

First NameLast Name
What Is Your Relationship To The Person?
Does The Person Know That You Are Making This Complaint?

YesNo
Does The Person Consent To The Complaint Being Made?

YesNo
Who is the person, or service about whom you are submitting a complaint about?
Name

First NameLast Name
Contact Details (If Known)
What Is Your Complaint 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.
Statement of Complaint*
Supporting Information: Please attach copies of any documentation that may help us to investigate your complaint (for example letters, references, emails etc.).
Supporting Information

Browse Files

Cancelof
What outcomes are you seeking as a result of the complaint?
Resolution Requested*
Should be Empty:

Complaints Form

Fill in the details of the person who is making the complaint.

If you are making this complaint on behalf of another person provide the following details.

Who is the person, or service about whom you are submitting a complaint about?

What outcomes are you seeking as a result of the complaint?