Complaints and Feedback

Which service or team of Thrive365 are you writing about?
We encourage you to raise issues with the relevant member of staff providing the service in the first instance.
Date of Incident*
Date Format: MM slash DD slash YYYY
Time of Incident*

: HH

MM
Have you discussed the issue with the relevant service?
- Yes
- No
Did the incident occur during service delivery?*
- Yes
- No
Were there any witnesses of the incident?*
- Yes
- No
Witness Name
Witness Position
Witness Email
Witness Phone Number
Were other clients involved or witness the incident?
- Yes
- No
Client Name
Client Email
Client Phone Number

What would you like to tell us?*
If you have any further documents relating to your feedback can you please email them to [email protected]
What would you like to happen now?
Please provide details of the matter (if insufficient space above)

Would you like a response to your complaint/feedback?
- Yes
- No
Name
If 'Yes' please provide your contact details: Note: You may make a complaint anonymously if you prefer though you will not receive a response and if you do not provide enough information, we may not act on, or be able to resolve your complaint or concerns.
First Last
Feedback provided on behalf of
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Contact Phone Number
Signature
Date
Date Format: MM slash DD slash YYYY
I prefer contact by
- Phone
- Email
- Letter
- N/A
Important Notice
Note your feedback will go to Thrive365’s feedback email which will be forwarded to the relevant Business Area. We will keep your personal information confidential as far as possible. However, there may be some circumstances when your personal information will need to be provided to others as part of the process of addressing your complaint. Personal information may also be released under the provisions of the Privacy Act 1998 and may be subject to release under the Freedom of Information Act 1989. We will keep this form as part of our Directorate records. The Directorate collects, manages, uses and discloses personal information under the requirements of the Information Privacy Act 2014 and the Health Records (Privacy and Access) Act 1997.

Important Notice