Compliments and Complaints Form

Name of Person

This section can be left blank if you would like to provide the compliment or complaint anonymously.

First Name

Last Name

Phone

(###)

###

####

Name of Representative

This section can be left blank if you would like to provide the compliment or complaint anonymously.

First Name

Last Name

Phone of Representative

(###)

###

####

*

I am satisfied about the services overall?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am likely to recommend your service in the future?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Do you consent to the Avenues Australia providing information to a third party (e.g. another Provider or external organisation) to resolve your issue?

Yes

No

Not Applicable