Feedback and Complaints Date you are lodging the complaint* DD slash MM slash YYYY What is your relationship with So Joe?*I am a: Select All Participant Staff member Provider Other Subject of your complaint*What would you like to provide feedback about? Select All Service delivery Staff member Provider Participant Other Description of your complaint*Desired Outcome*Would you like to remain anonymous?* Yes No Personal DetailsName First Last PhonePosition Email Address Street Address City State Post Code Would you like us to contact you?* Yes No How would you prefer we contact you?* Select All Telephone Email In person In writing via post Through an advocate/representative Participants or their advocates may lodge an appeal if they disagree with the decision made by the company, or by a staff member. An appeal should be made in writing or by email and submitted to the Board. NDIS Commission Phone 1800 035 544 or TTY 133 677 Relay Service Phone 1800 555 660 and request 1800 035 544 Complaints Form – www.ndiscommission.gov.au/about/ complaintsfeedback/complaints NSW Ombudsman Phone 1800 451 524
