Complaints - NDIS

Participant First Name
Please enter the participant's first name.
Please enter the participant's first name.
Participant Last Name
Please enter the participant's last name.
Please enter the participant's last name.
Participant NDIS Number
Please enter the participant NDIS number.
Please enter the participant NDIS number.
Participant Email
Please enter the participant's email.
Please enter the participant's email.
Participant Phone Number
Please enter the participant's phone number.
Please enter the participant's phone number.
Is the person filling out this form the participant?*
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Please answer the question.

Please fill in this section if you answered 'No' to the above question 'Are you the participant?'.

Does the participant know you are making this report?
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Does the participant consent to the concern being raised?
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Your details

Name
Please enter your name.
Please enter your name.
What is your relationship to the participant?
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Please answer the question.
Email
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Please enter your email.
Mobile Phone
Please enter your mobile phone.
Please enter your mobile phone.
Organisation Name
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Postal Address
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Phone Number
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Complaint details

Who are you making the report about?*
Include details such as name of the person/organisation, phone number, email address, postal address etc. (Limit of 200 characters)
Please enter details and limit your answer to 200 characters (including spaces).
Please enter details and limit your answer to 200 characters (including spaces).
Details of complaint*
Limit of 200 charcters
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Please enter details and limit your answer to 200 characters (including spaces).
What outcomes are you seeking?*
Limit of 200 characters
Please enter details and limit your answer to 200 characters (including spaces).
Please enter details and limit your answer to 200 characters (including spaces).
Have you made a report about this to another body?
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Please answer the question.
Details of previous report including any outcomes*
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Please enter details.
Please upload any supporting evidence or documentation here (PDF, JPEG or PNG)
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Date
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By submitting this form you consent to ALHCA proving information to a third party such as the NDIA to resolve your issue.