Complaints Form

Participant Complaints Form

Fill in Anonymously

Yes I'd like to remain anonymousNo I'd like to share my details (Please note that if you are making your complaint anonymously we may be unable to respond to your complaint and let you know what is happening)

Type of Enquiry

I am Making a ComplaintI would like to provide Feedback

Name:

Phone:

Email:

Postal Address

Assistance with Form

Fill in this box if someone is assisting you to complete this form. Please note that by listing a representative, you are giving EPSA authority to liaise with this representative on your behalf.

Name of Representative

Organisation

Phone Number

Email Address

Details of Feedback / Complaint

Date the Challenge or Concern arose

Who was involved

*Please some details to help us understand your concerns. You can include what happened, where it happened and who was involved or the decision you are unhappy about. Or Please let us know what feedback you would like to provide us.

What outcome(s) are you seeking? Do you want us to change anything in the future?

How would you like us to let you know about the progress of your complaint/feedback?

To me:

In personBy PhoneBy EmailBy Mail

To my Representative:

In personBy PhoneBy EmailBy Mail

Please attach any supporting information

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You can also give feedback to the NDIS Commission: They take feedback or complaints about services that you are not happy with. You can call them on: 1800 035 544. Or you can call the National Relay Service and ask for 1800 035 544.

You can also do this online here: https://www.ndiscommission.gov.au/participants/complaints. You can also call the NDIA on 1800 800 110. You may seek support from family, a friend or an independent advocate when making a complaint.

For further information about disability advocacy please visit the NDIS Commission website.

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