Complaint Form

NDIS Participant's Name (optional):

Phone Number (optional):

Email Address (optional):

Please provide a brief description of your complaint:

Which aspect of the NDIS does your complaint relate to?

When did the issue occur? (Please provide specific dates if possible):

How has this issue affected you or the NDIS participant?

Do you consent to us using your personal information to investigate and respond to your complaint?

Yes No

Please list any documents or evidence you have that supports your complaint (e.g., correspondence, reports, photos). Note: You will be given instructions on how to submit these documents after completing this form.

Consent to Use Complaint:

Yes No

I consent to my complaint being used for improvement purposes.