Complaint Form

Complaint
form

Foot Balance Technology provides scope for NDIS participants to voice any complaints they may have about our services.

Please complete the form and submit it. We will contact you as soon as possible.

PART A

Participant information
DD slash MM slash YYYY

PART B

About the Participant (if different to above)
Fill in this box if you are complaining on behalf of someone else
Does the person know you are making this complaint?
Does the person consent to the complaint being made?

Fill in this box if someone is assisting you with the complaint
for example a family member, your nominee or representative

My preferred contact is

PART C

Your complaint
What is your complaint about?
Provide some details to help us understand your concerns. You can include what happened, where it happened and who was involved or the decision made by the Agency that you are unhappy about.

PART D

What outcomes are you seeking?

PART E

Further information
Supporting information
Please attach copies of any documents that may help us investigate your complaint (for example letters, references, emails).
If you cannot do this, please tell us what you think we should obtain.

Have you made a complaint about this to another agency?
(For example: a disability service or equal opportunity agency, Health Care Complaints Commission, Ombudsman.) If so, please provide details of the agency to which you made your complaint and any outcome. Please also attach copies of any letters you have received from that agency.

PART F

Uploads
If you would like to upload any other documents please add below.
Drop files here or
Max. file size: 2 MB.
    Drop files here or
    Max. file size: 2 MB.
      Drop files here or
      Max. file size: 2 MB.
        Previous Next
        Close
        Test Caption
        Test Description goes like this