Compliments & Complaints

Please let us know what we do well and where we can improve our services.

This is a:

Compliment
Complaint
Feedback

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Your Details

Your Name

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Last

Postal Address

Telephone Number

Mobile Number

Email Address

Do you require an interpreter?

If yes, which language?

Are you providing feedback on another person’s behalf?

Feedback made on another person’s behalf

Your Name

First

Last

Postal Address

Telephone Number

Mobile Number

Email Address

Please provide details of your relationship to the person on whose behalf you are acting:

Are you a legal representative for the person who received the service? (e.g. parent of a child under 18 years or guardian )

If yes, please provide details:

If no, please provide the reason why:

Are we able to speak with the person who received the service?

If no, please provide the reason why:

Please provide details of the service that the feedback concerns

Name of the service Provider

Address of office location of service

Contact person’s name and position in the service

Please state your concerns

Please provide details of your main 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 your concerns with the service Provider or another agency or person for assistance with these concerns?

If yes, with whom and what was the outcome?

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

Let us know here!

Privacy

Accomplished Choice Solutions Pty Ltd 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.

Accomplished Choice Solutions Pty Ltd will only use your information in accordance with relevant privacy and other laws.

If you choose to remain anonymous, Accomplished Choice Solutions Pty Ltd may be unable to deliver the full range of services you require.

If you wish to contact Terrie Pannowitz who is responsible for managing the personal information that you provide on this form, please call 0405300444.

Declaration

Signature

Date

Your Details

Feedback made on another person’s behalf

Please provide details of the service that the feedback concerns

Please state your concerns

What action have you already taken in relation to this feedback?

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

Privacy

Declaration

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