Online health service complaint form

If you’re not satisfied with a 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 it is your right
to make a complaint.

 Have you raised your concern with the health service provider?

Before making a complaint, try talking with your health service provider—this is often the quickest and
easiest way to address your concerns or fix a problem. Visit our website for advice on talking with your
provider.

Contact us if you’re not satisfied with their response, or it is too difficult or upsetting for you to contact
the health service provider.

 Use this form to make a complaint.

This form must be completed and submitted in one session. You cannot save a partially completed form.
Please have on hand 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.

This form is for individuals making a complaint about a health service they received. Contact us if you:

  • wish to make a complaint on behalf of someone else
  • are a Queensland registered health practitioner, employer or health educator wishing to make a notification.

Contact us if you need help to fill in the form.

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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Female
Male
Indeterminate/Intersex/Non-specific/Unspecified

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Yes
No

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No

Details of the person you are complaining on behalf of



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Female
Male
Indeterminate/Intersex/Non-specific/Unspecified

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Yes
No

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No

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No

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No



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Who is this complaint about?

(Please include as much information as possible)


Health service provider 1:



Individual
Organisation


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Yes
No

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Yes
No

Health service provider 2:



Individual
Organisation


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No

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How have you tried to resolve this complaint?



Yes
No

Give the health service provider time to respond before making a complaint to us (see Time limit). If you have received a response from the provider, attach a copy



Yes
No


Yes
No

 


Yes
No


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Time limit

Under some circumstances the Health Ombudsman may decide not to deal with your complaint if the issues arose, and you were aware of them, at least 2 years ago.


Your Complaint


Tell us:

• What happened • Who was involved • When and where it happened • When you become aware of the problem • The main issues you are concerned with.

Attach copies of any supporting information—letters, reports, photos, invoices.

 





Access
Acknowledgement
Apology
Complaint Recorded
Costs
Explanation
Fees Waived
Information or advice
Policy/process change
Provider education
Records
Refund
Remedial treatment
Response
Treatment or health service
Other


We will try to help you and your health service provider resolve your complaint.

We have no powers to force an outcome but as an independent agency, we decide when a complaint has been adequately considered. Here are some important things to keep in mind:

We don’t take sides • We don’t lay blame or award compensation

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 don't want them to receive, please let us know

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

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

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