Compliments, Complaints and Feedback

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Preferred communication method
Phone

Complaint And Feedback Form

If you would prefer to complete the form anonymously, then, please feel free to leave the name, address and contact boxes blank. However, the Complaints
Team/Manager will not be able to contact you to obtain additional information/ reach you to notify you of the results of the investigation.

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Is this a compliment, complaint or other feedback?*
Preferred communication method*
First Name
Last Name
Email Id
Phone

Other person’s consent for feedback made on their behalf

If you are providing this feedback on another person’s behalf, we require the consent of the other person to obtain and pass on personal information relevant to this feedback. Please provide evidence of this consent when submitting this form, e.g., signed consent (as provided below) from the person on whose behalf you are acting.

I, (insert name of person giving consent) give permission to (insert name of person receiving consent) to provide or collect relevant information on my behalf to assist with this complaint/compliment or feedback, as necessary.

Signature: Date:

Privacy

BIHC is committed to protecting your privacy. We collect and handle personal information that you provide on this form for the purpose of investing and responding to your complaint, compliment, and feedback.

BIHC will only use your information in accordance with relevant privacy and other laws. For us to provide services to you effectively and efficiently, we may need to share your personal information with others, such as advocacy or health-related organisations or businesses, to assist with any concerns identified.

If you choose to remain anonymous, BIHC may be unable to respond to your complaint, compliment, or feedback.

If you wish to contact BIHC about the information that you provide on this form, please call 02 9051 1000 or email [email protected].

You also have the right to access your information and seek its correction under the Freedom of Information Act 1982. For information about making a Freedom of Information (FOI) application, please contact the Office of the Australian Information Commissioner on 1300 363 992

Declaration

Paragraph declaring information provided is true and correct.

Signature: Date:

Thank you for taking the time to provide feedback about our service.