Complaints / Feedback Form

Instructions:

1. Complete this form

2. Forward with information to our Complaints Manager via email, website or post

Email	info@wrightcare.com.au
Website	www.thewrightcare.com.au
Postal Address	PO Box 1059 Murray Bridge, South Australia, 5253

3. The Complaint Manager will contact you upon receipt of this form.

Note: You can send in the Anonymous Complaints and Feedback form in the stamped self-addressed envelope that you received at intake.

Are you the person making the complaint / providing feedback? *

YesNo

Are you making the complaint/feedback on behalf of another person? *

YesNo

Does the person know you are making this complaint/providing feedback *

YesNo

Does the person consent to the complaint/feedback being made *

YesNo

Name of the Person *

Address *

Mobile Number *

Email Address *

My preferred contact method is *

Your Name *

What is your relationship to the person? *

Complaint/Feedback Details

Who is the person, or the service about whom you are complaining or providing feedback about? *

Name *

Contact details (if known)

What is your Complaint/Feedback 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. *

Supporting Information Please attach copies of any documentation that may help us to investigate your complaint/feedback (for example letters, references, emails).

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What outcomes are you seeking because of the complaint/feedback? *

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