Feedback

What is your feedback or complaint about?*

Scope in general
A Scope service
A Scope staff member

Which service?

What is their name?*

Would you like to identify yourself

Yes
No

Please note that since you are providing this feedback/complaint anonymously, we will not be able to send you an acknowledgement letter or keep you involved in the resolution process. Your feedback/complaint information will still be processed and kept confidentially

1. Tell us a bit about yourself.

Name*

First Last

Your email address

Phone number

Address

Street Address Suburb State Post Code

2. Explain your situation.

What is your feedback or complaint?*

Please provide as much detail as possible, e.g. who, what, where, when, witnesses

What would you like to see happen about your feedback or complaint?

Some more details

Are you making the complaint on behalf of someone else?*

Yes
No

What is your relationship with them?*

Name of the person receiving the service?

First Last

Does the person know you are making the complaint on their behalf?

Yes
No

Consent*

I acknowledge that the information provided in this form is correct.

Name

This field is for validation purposes and should be left unchanged.

1. Tell us a bit about yourself.

2. Explain your situation.

Some more details

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