Feedback or Complaint Form

Who is completing this form? Please let us know whether you are the NDIS participant yourself, or you are submitting this form on someone else's behalf.*
- I am the NDIS Participant providing feedback / making the complaint.
- I am acting on behalf of the NDIS participant to provide this feedback / make the complaint.
Do you wish to provide anonymous Feedback?*
- Yes. I would like my feedback/complaint to be anonymous.
- No. My feedback/complaint does not need to be anonymous.
If you choose to remain anonymous we will not collect your personal information. Please note: that individual follow-up actions are not be possible for anonymous feedback.

Your Feedback or Complaint*
Actions from Feedback
Please let us know what actions you would like to see happen from this feedback / complaint.

Consent for Information Sharing*
- I give consent for 4gr to request and receive relevant information about me relating to this complaint / feedback from persons or organisations involved in the complaint.
- I do not consent for 4gr to request and receive relevant information about me relating to this complaint / feedback from persons or organisations involved in the complaint.
Permission for Contact Person*
- I give permission for the contact person nominated in this form to provide or receive information on my behalf to assist with this complaint / feedback, if required.
- I do not give permission for the contact person nominated in this form to provide or receive information on my behalf to assist with this complaint / feedback, if required.
Email
This field is for validation purposes and should be left unchanged.

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