Complaint and Feedback Form

If you have a concern about Quality Care Support Service, our support workers, or services, it is important to talk about it. Anyone receiving NDIS supports or services can make a complaint.

Your family or friends can also talk to our independent Complaints Manager on your behalf.

To make a complaint or to provide feedback, you can complete this Complaint and Feedback Form and e-mail it to our independent Complaint Manager: ndisfeedback@eighteen33.com.au

What is your feedback or complaint about?

Participant Support: I am a participant or their representative and need help understanding my Support Plan, change of circumstance or other matter

Complaint: I would like to provide a complaint

Feedback: I would like to submit feedback to QCSS

Compliment: I would like to provide a compliment about QCSS

Participant details

Full Name:

NDIS number:

Address:

Email:

Mobile phone:

Home phone:

Your details (optional – You can remain anonymous)

Full Name:

Relationship to Participant:

Address:

Email:

Mobile phone:

Home phone:

Message / Details of complaint

If you are providing a complaint, please complete the following:

If you are providing a complaint, please complete the following:

Yes

Please provide details of the organisation and any outcomes:

What outcomes are you seeking?

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Complaint and Feedback Form

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