COMPLAINT FORM

ABOUT YOU:

First Name of Participant: *

Last Name of Participant: *

NDIS Number: *

Contact Number: *

Email: *

FILL IN THIS SECTION IF SOMEONE IS ASSISTING YOU WITH THE COMPLAINT:

Name of advocate / representative: *

Organization: *

Contact Number: *

Contact Email: *

YOUR COMPLAINT (Please provide some details to help us understand your concerns. You can include details about what happened, where it occurred, who was involved, the decision made that you are unhappy about, and the outcomes you are seeking): *

Please attach any supporting documentation that may help us investigate your complaint.

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