Easy English complaints form - Headway Gippsland Inc.

Make a complaint

Your name

Your phone number

Will some one help you with this form?

no

yes - who?

Name

Phone number

Who is the complaint about? Like the

● name of the person

or

● the place you go to.

When did it happen?

Did you tell them about it?

no

yes - what did they do?

Tell us what took place.

● in the order it took place.

What do you want to happen?

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