Complaints & Feedback

your voice matters

Complaint and feedback form

A complaint form is a formal way of letting someone know you are unhappy about something. We are here to help you! Please tell us what happened so we can support you. After filling in this form, we will listen to you and your problem and work on a solution.

Your name and contact details

You are not alone! We are here to listen and support you. Please give this form to a trusted staff member or bring it to our office.

First Name

Family Name

Phone

Date

Address

I would like to be contacted by

Phone Email In writing

Tell us about your concern. A ‘concern’ is something that might be making you or someone else feel unhappy, frightened or angry.

Who Was There? (Do you know the names of the people involved?)

Where Did It Happen? (Place or location)

When Did It Happen? (Do you know the date or time?)

Has This Happened Before?

Yes No Not sure

If yes, how many times?

Did Anyone See What Happened? (Who was there? Can we talk to them?)

How Do You Feel? (You can write or choose words like sad, scared, angry, confused, or any other feelings.)

Complaints & Feedback

your voice matters

Complaint and feedback form

Your name and contact details

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