{"id":54,"date":"2025-07-18T10:12:37","date_gmt":"2025-07-18T10:12:37","guid":{"rendered":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/?page_id=54"},"modified":"2025-07-18T10:19:23","modified_gmt":"2025-07-18T10:19:23","slug":"client-complaints-feedback-form","status":"publish","type":"page","link":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/client-complaints-feedback-form\/","title":{"rendered":"Client Complaints Feedback Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"54\" class=\"elementor elementor-54\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d9fe3a9 e-flex e-con-boxed e-con e-parent\" data-id=\"d9fe3a9\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a4f42bd elementor-widget elementor-widget-shortcode\" data-id=\"a4f42bd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f56-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"56\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/54#wpcf7-f56-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"56\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f56-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"form_Sec\">\n\t<p class=\"w-100\">If you have any concerns or complaints regarding your current NDIS support or services offered by Disability Services 24\/7, it is crucial to address them. Please complete the complaint form provided below, and we will aim to respond within three business days.\n\t<\/p>\n\t<p class=\"w-100\">We are committed to maintaining the confidentiality of any information provided in a complaint and throughout the complaints process. Information will only be disclosed if mandated by law or if it is deemed appropriate in the given circumstances.\n\t<\/p>\n\t<p class=\"w-100\" style=\"margin-bottom:0;\">You have the option to submit a complaint anonymously by following these steps:\n\t<\/p>\n\t<p class=\"w-100\" style=\"margin-bottom:0;\">(a) Call us at <a> 0430 431 318 <\/a> and indicate that you want to file an anonymous complaint, ensuring that we do not request your identification.\n\t<\/p>\n\t<p class=\"w-100\">(b) Complete the Client's Complaints and Feedback Form without including your name or any other identifying details in the table below. Then, send it to 78 Long Forest AveHarkness VIC 3337.\n\t<\/p>\n\t<p class=\"w-100 fw-bold\">1. Kindly enter your information:\n\t<\/p>\n\t<div class=\"formGroup\">\n\t\t<p><label>Date of Submission<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ccff1\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>Full Name<\/label>\n\t\t<\/p>\n\t\t<div class=\"twoCol justify-content-between align-items-center gap16\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"ccff2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First name\" value=\"\" type=\"text\" name=\"ccff2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last name\" value=\"\" type=\"text\" name=\"ccff3\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>Contact Number<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff4\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel form-control\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"ccff4\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>Email Address (e.g. name@company.com)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff5\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email form-control\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"ccff5\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"formGroup\">\n\t\t<p><label>Your Role<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff6\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" placeholder=\"Client \/ Family member or friend \/ Advocate \/ Carer \/ Staff Member \/ Other\" value=\"\" type=\"text\" name=\"ccff6\" \/><\/span>\n\t\t<\/p>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>2. Is this complaint being filed on behalf of an individual with a disability?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff7\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"ccff7\" value=\"Please select\" \/><span class=\"wpcf7-list-item-label\">Please select<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"ccff7\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"ccff7\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>3. Do you need any assistance with communication or other support services? (e.g., Interpreter)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff8\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"ccff8\" value=\"Please select\" \/><span class=\"wpcf7-list-item-label\">Please select<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"ccff8\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"ccff8\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>If assistance is needed, please specify the type of support required<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff9\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"ccff9\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>4. Detail your complaint.<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff10\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" placeholder=\"(Attach additional pages if necessary)\" name=\"ccff10\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>5. What outcome are you seeking with this feedback or complaint?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff11\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"ccff11\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>6. Consent *<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff12\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"ccff12[]\" value=\"I confirm that the details provided in this Client&#039;s Complaints and Feedback Form are accurate.\" \/><span class=\"wpcf7-list-item-label\">I confirm that the details provided in this Client&#039;s Complaints and Feedback Form are accurate.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p class=\"w-100 fw-bold\" style=\"margin-bottom:0;\">7. Right to Seek Advocacy\n\t\t<\/p>\n\t\t<p class=\"w-100\">You have the option to engage support from a relative, friend, or an independent advocate when lodging a complaint. Should you need an advocate or representative, inform us, and we will ensure to collaborate with and facilitate any required support from advocates (including independent ones) or representatives.\n\t\t<\/p>\n\t\t<p class=\"w-100 fw-bold\">8. How to Submit a Complaint to the NDIS Commission\n\t\t<\/p>\n\t\t<p class=\"w-100\">A complaint can be submitted to the NDIS Commission via:\n\t\t<\/p>\n\t\t<p class=\"w-100\">Telephone: <a href=\"tel:1800 035 544\"> 1800 035 544 <\/a> (free call from landlines) or TTY 133 677. Interpreter services available.\n\t\t<\/p>\n\t\t<p class=\"w-100\">National Relay Service, then request <a href=\"tel:1800 035 544\"> 1800 035 544 <\/a>\n\t\t<\/p>\n\t\t<p class=\"w-100\">Online at <a href=\"https:\/\/www.ndiscommission.gov.au\/about\/complaints\">https:\/\/www.ndiscommission.gov.au\/about\/complaints <\/a> , by filling out a complaint contact form.\n\t\t<\/p>\n\t\t<p class=\"w-100\">The NDIS Commission addresses complaints related to:\n\t\t<\/p>\n\t\t<p class=\"w-100\">Unsafe or disrespectful service delivery\n\t\t<\/p>\n\t\t<p class=\"w-100\">Substandard quality of services or supports\n\t\t<\/p>\n\t\t<p class=\"w-100\">Complaints can be made anonymously to the NDIS Commission.\n\t\t<\/p>\n\t\t<p class=\"w-100 fw-bold\">9. Further Information\n\t\t<\/p>\n\t\t<p class=\"w-100\">Fact sheet: How to Lodge a Complaint\n\t\t<\/p>\n\t\t<p class=\"w-100\">Video: Navigating Complaints\n\t\t<\/p>\n\t\t<p class=\"w-100\">The NDIS Complaints Management and Resolution Guidance document provide comprehensive details on the NDIS Commission\u2019s complaint-handling process.\n\t\t<\/p>\n\t\t<p class=\"w-100 fw-bold\">10. For Internal Use Only\n\t\t<\/p>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>Recorded in Complaints Register?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff13\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ccff13\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>Complaint Manager<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff14\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ccff14\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"formGroup\">\n\t\t\t<p><label>Complaint Reference Number<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ccff15\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ccff15\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"subBtn\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner prime-btn\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-54","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/54","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/comments?post=54"}],"version-history":[{"count":4,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/54\/revisions"}],"predecessor-version":[{"id":59,"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/pages\/54\/revisions\/59"}],"wp:attachment":[{"href":"https:\/\/disabilityservices247.com.au\/disabilityServiceForms\/wp-json\/wp\/v2\/media?parent=54"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}