Make a complaint

Health service complaint form

If you’re not satisfied with a health service provided by a health service provider, or you’re concerned with the health, conduct or performance of a registered or unregistered health practitioner, then this is important to us and it is your right to make an enquiry or complaint to us.

This form must be completed and submitted in one session. Unfortunately, you cannot save a partially completed form. Please try to ensure you have all information and documentation about your complaint.

Alternatively, you can download a complaint form to complete, and email or print and post back to us.

Please contact us if you need help to fill in the form – we are very happy to assist you.

All fields marked as (Required) must be entered. Please provide as much information as you can, so we can help you.

Your Details



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No

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Details of the person you are complaining on behalf of



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Female
Male
Non-binary/Gender Diverse
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Demographic information

We collect demographic information so that we can understand the needs of the people using our service. We manage your personal details in accordance with the Information Privacy Act 2009, details of this are outlined in our privacy policy.


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Female
Male
Non-binary/Gender Diverse
Prefer not to answer

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Who is this complaint about?

(Please include as much information as possible)


Health service provider details:



Individual
Organisation


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Yes
No

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Complain about another person or facility involved


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Health service provider 2 details:



Individual
Organisation


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How have you tried to resolve this complaint?



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Your Complaint


It will be helpful if you can tell us:

  • What concerns happened with the health service
  • Do you know who was involved
  • Are you aware of when and where it happened
  • What are the main issues you are concerned with.

Please attach copies of any supporting information—letters, reports, photos, invoices if you have them.

 





We will try to help you resolve your complaint and we can do this in a variety of different ways depending on the nature of your concerns.

We will keep your complaint on record to help us identify patterns of provider practice, complaint trends, or systemic issues.

Access to records / Access to health records




I am complaining about the service/treatment provided to me and I understand the Office of the Health Ombudsman may need to access my personal health information for the purpose of handling this complaint. Access to this information will be in accordance with the Act.


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I am complaining about the service/treatment provided to the consumer and I understand the Office of the Health Ombudsman may need to access their personal health information for the purpose of handling this complaint. Access to, and disclosure of this information will be in accordance with the Act.
I am the parent/appointed guardian of the person who received the service/treatment.

I am complaining about the service / treatment provided to a person who has died.

The consumer has asked me to make the complaint.



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Before you send this form, please check that you have:

  • included as much relevant information as possible
  • given details of the health service provider you are complaining about
  • clearly identified your concerns
  • consented to us accessing your healthcare information
  • attached copies of supporting documents or information—please do not send original documents.

Privacy and confidentiality

In managing your complaint, we collect personal information about you.

We comply with the Information Privacy Principles in the Information Privacy Act 2009.

We are required to provide your complaint to the person and/or organisation you have named. If there is any information you do not want them to receive, please let us know.

We will not disclose your personal information to anyone else unless you consent or the disclosure is allowed, authorised or required by law.

If your complaint is about a registered practitioner, we will advise the Australian Health Practitioner Regulation Agency of your complaint.

You can apply to access or amend documents held by us under the Information Privacy Act 2009 and the Right to Information Act 2009. Some documents - for example those containing the personal information of other people - may be exempt from access.

It is an offence for a person to provide false or misleading information to the Office of the Health Ombudsman.