Complaint Form

 
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Please enter the date of the incident relating to the complaint:
Please describe what happened and the nature of your complaint:
Please select the employees involved in the incident:

We are sorry that you are unhappy and appreciate you letting us know. Please click the PREVIEW button to review your answers before submitting your complaint to the Clinic Manager.

What was the date of the treatment that relates to this complaint?
Please explain the nature of your complaint in relation to your treatment outcome:
If possible please upload any photos which show the nature of your complaint.
Files must be less than 2 MB.
Allowed file types: jpg jpeg.
Who was present during your service provision?
Which review appointments have you already attended?

We are sorry you are unhappy with your treatment outcome and appreciate you letting us know. Please click PREVIEW to review your answers before submitting your complaint to the Clinic Manager.