Complaints and Feedback Stay Connected Feedback/Complaints Form Fill in the details of the person who is making the complaint/ providing feedback First Name Last Name Email Address Phone Number Address Relationship with the NDIS participant Who is the person, or what is the service, about whom you are complaining or providing feedback about? Name of Participant Email of the participant Name of Service Please SelectComplex Behaviour SupportMental Health SupportIndividual Support24 Hours Accommodation SupportCommunity ParticipationRespite Care Who is the complaint regarding? Please SelectSupport WorkersSupport TeamManagementOther Does the person know you are making this complaint/providing feedback? YesNo Check this box if you wish to remain anonymous? YesNo What is your Complaint/Feedback about? Would you please attach copies of any documentation that may help us to investigate your complaint/feedback (for example letters, references, emails)? What outcomes are you seeking because of the complaint/feedback?
