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.

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

Your Details

Title

(Required)

select

First Name

(Required)

Last Name

(Required)

Middle Name

Gender

(Required)

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

Date of birth

Open the calendar popup.

Street address

(Required)

City/Suburb

(Required)

State

(Required)

select

Post code

(Required)

My preferred method of contact

(Required)

select

Phone

Mobile

(If you wish to receive a confirmation email with details of your complaint please enter a valid email address)

Confirm Email

How did you hear about us?

(Required)

select

Do you identify as Aboriginal and/or Torres Strait Islander?

(Required)

select

Your preferred language?

(Required)

select

Your country of birth?

select

Do you need an interpreter?

(Required)

Yes
No

Do you have any special needs?

(Required)

Yes
No

Please Specify

(Required)

Are you making this complaint on behalf of someone else?

(Required)

Yes
No

Details of the person you are complaining on behalf of

Title

(Required)

select

First Name

(Required)

Last Name

(Required)

Middle Name

Gender

(Required)

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

Date of birth

Open the calendar popup.

What is your relationship to the person you are complaining on behalf of?

(Required)

select

Does the person identify as Aboriginal and/or Torres Strait Islander?

(Required)

select

Has the person asked you to make this complaint?

(Required)

Yes
No

Is the person a child?

(Required)

Yes
No

Has the person died?

(Required)

Yes
No

Date the person died

(Required)

Open the calendar popup.

Are the persons contact details the same as yours?

(Required)

Yes
No

Street address

(Required)

City/Suburb

(Required)

State

(Required)

select

Post code

(Required)

Phone

Mobile

Who is this complaint about?

(Please include as much information as possible)

Health service provider 1:

Is the provider of the health service an individual practitioner or organisation (eg. hospital) ?

(Required)

Individual
Organisation

Health provider's name

(Required)

Type of health service provider

(Required)

select

Street address

(Required)

City/Suburb

(Required)

State

(Required)

select

Post code

(Required)

Health service provider phone

Health service provider mobile

Health service provider email

Can you provide the contact details of someone from the health provider?

(Required)

Yes
No

Title

(Required)

select

Health provider contact first name

(Required)

Health provider contact last name

(Required)

At least one of phone or mobile below must be entered

Health provider contact phone

Health provider contact mobile

Health provider contact email

Health provider contact position

(Required)

Health practitioner's business name

(If Applicable)

Title

(Required)

select

Health practitioner’s first name

(Required)

Health practitioner’s last name

(Required)

Street address

(Required)

City/Suburb

(Required)

State

(Required)

select

Post code

(Required)

Health practitioner's phone

Health practitioner's mobile

Health practitioner's email

Add another health service provider?

(Required)

Yes
No

Health service provider 2:

Is the provider of the health service an individual practitioner or organisation (eg. hospital) ?

(Required)

Individual
Organisation

Health provider's name

(Required)

Type of health service provider

(Required)

select

Street address

(Required)

City/Suburb

(Required)

State

(Required)

select

Post code

(Required)

Health service provider phone

Health service provider mobile

Health service provider email

Can you provide the contact details of someone from the health provider?

(Required)

Yes
No

Title

(Required)

select

Health provider contact first name

(Required)

Health provider contact last name

(Required)

At least one of phone or mobile below must be entered

Health provider contact phone

Health provider contact mobile

Health provider contact email

Health provider contact position

(Required)

Health service organisation's name

(If Applicable)

Title

(Required)

select

Health practitioner’s first name

(Required)

Health practitioner’s last name

(Required)

Street address

(Required)

City/Suburb

(Required)

State

(Required)

select

Post code

(Required)

Health service provider phone

Health practitioner's mobile

Health service provider email

How have you tried to resolve this complaint?

Have you already complained to the health service provider?

(Required)

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

Attach a copy
You can add up to 5 files (one at a time) with a maximum file size each of 10mb (pdf , rtf , txt , jpg , bmp , gif , png , tif). Please note that the form submission may take a while if you attach large files.

Have you already complained to another entity?

(Required)

Yes
No

Please provide the name of the entity and a reference number if one was provided

Has the complaint been reported to the Crime and Corruption Commission?

(Required)

Yes
No

If yes, please provide a reference number

Comments (e.g. assessed and referred/assessed at Cat 3 referral not required)

Characters remaining 20000

Spell Check

Has the information provided in the complaint been assessed as a public interest disclosure?

(Required)

Yes
No

If yes, who is the discloser

Date the health service was provided

Open the calendar popup.

If the health service was more than two years ago, when did you become aware of the problem?

Open the calendar popup.

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.

Summarise your complaint

(Required) Characters remaining 20000

Spell Check

Attach supporting information such as letters, reports, photos, invoices
You can add up to 5 files (one at a time) with a maximum file size each of 10mb(pdf , rtf , txt , jpg , bmp , gif , png , tif). Please note that the form submission may take a while if you attach large files.

What would you like to happen to resolve your complaint?

(Required)

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

Other Outcome

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

(You are required to tick at least one of the items below)

Select below to confirm you are making a complaint about a health service provided to you
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.

Enter your name

(Required)

Date

(Required)

Open the calendar popup.

Select below to confirm you are making a complaint about a health service on behalf of someone else
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.

Enter consumer name

(Required)

Enter your name

(Required)

Date

(Required)

Open the calendar popup.

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