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Easy-to-use complaint form

Most providers find that feedback (positive and negative) helps them identify what will improve the quality of their service.  Here is an example of an easy-to-use complaint form.  (Download this form as a Word document (25Kb).

Name of consumer


Name of the person making the complaint (if not the consumer)


Relationship to the consumer


Contact address


Phone
Home
Work
Mobile


Fax
Email


Name of provider/person you want to complain about


Name of the service


Describe what happened (attach extra pages if needed)





Desired outcome (what you want to happen as a result of this complaint)



Date this happened:


Signature