Website Complaint Record

Complaint Record

CCA 112 - Complaint Form - Feb 22 V. 1D
You can raise a concern/make a complaint about any part of your service without fear of consequences. We value your opinion and will work with you to resolve any issues in a manner and via a communication method that best suits you. For further information, refer to our Complaints Information Sheet on our Resources page.
Name

First NameLast Name
Email
example@example.com
Who has raised this complaint*
If anonymity is requested, please enter "anonymous"
Person Involved*
Participant this complaint is in reference to
Contact Details*
Name, Phone number, Email address etc
Details of the complaint*
Would you like to involve an advocate or additional support to help facilitate a resolution?*

YesNo
What additional support is required?*
How would you like this complaint to be resolved?*
Who would you like to manage this complaint?*
Has this complaint been resolved?

YesNo
What was the resolution?*
Please include who has resolved this complaint
Next Steps: This complaint will be escalated to our quality department and if you've nominated someone to manage this complaint, they will also be notified.
Should be Empty: