Online Complaints Form - Anonymous

If you submit an anonymous complaint no-one will know your identity and this may limit what we can do to help resolve your concern. We will not be able to keep you informed about the progress of your complaint. You will not be able to provide more information to us and you will not have review rights.

Changed

Wednesday, 28 November 2018 - 10:06am

Please click on the check box below to confirm that you have reviewed the Notice of Collection that explains how we use personal information.

I have read the Notice of Collection *

Complainant information

My complaint relates to: *

The care or services I am receiving The care or services someone else is receiving

Details of your complaint

Complaints can relate to care, catering, financial matters, hygiene, equipment, security, activities, choice, comfort and safety or other matters related to the responsibilities of an service provider. We cannot provide advice on who can make financial and medical decisions on behalf of a person receiving care and cannot provide legal advice. If we cannot help you, we will try to refer you to someone who can (unless you have submitted an anonymous complaint).

Have you discussed your complaint with the service? *

Yes No

Have you contacted anyone else regarding this complaint? *

Yes No

Further details about who you have discussed this complaint with

What does your complaint relate to You can optionally upload up to 5 related files here

Select file:

Please select up to 5 files (Files can be of type doc, docx, xls, xlms, pdf or jpg) and have a maximum size of 25MB in total for all the files.

Details of aged care service

What type of aged care service does the complaint or information relate to *

Service name: *

Service State/Territory *

Street Address: *

Address Line 2:

City/Town/Suburb:

Postcode:

You are about to submit this complaint form to the Aged Care Quality and Safety Commission. If the matter you are raising involves a serious issue affecting the safety, health or wellbeing of a person receiving aged care, or if it relates to the commission of a serious offence, we may be obliged to refer relevant material to the appropriate external agency, including appropriate health professional regulatory bodies and the police.