Complaints and Feedback Form

We appreciate any suggestions, complaints and comments. To do so, you can speak to your advocate to complete this form. All information is strictly confidential.

We encourage you to make your complaint in writing. Please allow approximately one week for a response.

You can submit this form via this online form or in the following ways: E: learn@boorn.family

You can also submit a complaint on our website, contact us tab:

NDIS Families; You may also like to make a complaint directly to the NDIS Quality and Safeguard Commission Phone: 1800 035 544 or Online at: www.ndiscommission.gov.au

Personal Details

Are you a NDIS participant? *

Yes No unsure

This information will be used to contact you. If you wish to remain anonymous please leave blank.

First Name

Last Name

Email Address

Mobile Number

Complaint and Feedback History

Have you lodged a complaint or feedback with this service before? *

YesNo

Was the matter was satisfactorily resolved?

YesNoStill ongoing

Details of the Complaint/ Feedback

Is this a: *

Complaint FeedbackCompliment Other

Is there someone (legal representative/support person) that you would like involved in making this complaint? *

YesNo

Date situation occurred? *

Representative/ Support Person Contact Details

Where did it happen? *

Who was involved? *

Description of the complaint/ feedback. *

Were there any witnesses? *

YesNo

If yes, please list the witnesses’ full names as well as a contact number for each.

Have you spoken to someone about what happened? *

YesNo

If yes, what was the outcome?

If no, what was the reason you were unable to discuss the matter with the other person?

Resolution

How would you like this complaint resolved?

Please attach documents that may be of assistance in handling the complaint.

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Date complaint/ feedback submitted?

Signature *

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