Better health and ageing for all Australians

Aged Care Forms

Aged Care Complaint Scheme: Lodge a complaint online

The Aged Care Complaints Scheme is available to anyone who wishes to make a complaint about an Australian Government subsidised aged care service.

You can use this form to lodge a complaint with the Scheme. This online form is monitored during business hours only so if you have an urgent matter you should call the the Scheme on free-call 1800 550 552. A Complaints Resolution Officer from the Scheme will contact you during business hours to explain the complaints resolution process and to clarify any matters you have raised. They can also answer any questions you may have.


* Indicates a mandatory field. A mandatory field is a field within the form that must be completed to allow the the Scheme to deal effectively with the information you are providing. You will not be able to submit your information/complaint unless there is information in all fields marked as mandatory.


Lodging your complaint form with the Scheme
Lodge complaint as *
Open [?] Confidential [?] Anonymous[?]
Your details
Lodge complaint as:
Open Complaint

Title:*
First Name:*
Last Name:*
Street Address:*
Suburb:*
State:*
Postcode:*
Phone:*
Email:*
Preferred contact method & time:

Preferred contact times:
Complainant information
This complaint relates to: *
The care or services I am receiving
The care or services someone else is receiving
Details of care recipient If this complaint relates to the care and services a specific resident is receiving, you may add their details here.


First Name:
Last Name:
What is you're relationship with the person in care:
Is the care recipient aware that you are making a complaint on their behalf?
Yes No[?]
Does the care recipient consent to you making a complaint on their behalf?
Yes No
Are you authorised to make decisions on behalf of the care recipient?
Yes No
More Details
Please provide details as to why the care recipient is not aware of the complaint:
Details of your complaint
Have you discussed your complaint with the service?
Yes No
Have you contacted anyone else regarding this complaint?
Yes No
Further details about who you have discussed this complaint with
What does your complaint relate to:*
[?]


Provide specific details about your concern here: *


 [?]
Details of aged care service
Which type of aged care service does the complaint or information relate to:*
[?]
Name of service:*
Street address:
Suburb:
State or Territory:*
Postcode:*
Complaint resolution
Would you like to be involved in the resolution process?
Yes No
What outcome would you like from this complaint?
Would you like feedback on the resolution of this complaint?
Yes No
You are about to submit this complaint form to the Aged Care Complaints Scheme. If the matter you are raising involves a serious issue affecting the safety, health or wellbeing of a care recipient, or if it relates to the commission of a serious offence, the Department of Health and Ageing may be obliged to refer relevant material to the appropriate external agency, including appropriate health professional regulatory bodies and the police.


Your details
Lodge complaint as:
Confidential Complaint

Title:*
First Name:*
Last Name:*
Street Address:*
Suburb:*
State:*
Postcode:*
Phone:*
Email:*
Preferred contact method & time:

Preferred contact times:
Complainant information
This complaint relates to: *
The care or services I am receiving
The care or services someone else is receiving
Details of care recipient If this complaint relates to the care and services a specific resident is receiving, you may add their details here.


First Name:
Last Name:
What is you're relationship with the person in care:
Is the care recipient aware that you are making a complaint on their behalf?
Yes No[?]
Does the care recipient consent to you making a complaint on their behalf?
Yes No
Are you authorised to make decisions on behalf of the care recipient?
Yes No
More Details
Please provide details as to why the care recipient is not aware of the complaint:
Details of your complaint
Have you discussed your complaint with the service?
Yes No
Have you contacted anyone else regarding this complaint?
Yes No
Further details about who you have discussed this complaint with
What does your complaint relate to:*
[?]


Provide specific details about your concern here: *


 [?]
Details of aged care service
Which type of aged care service does the complaint or information relate to:*
[?]
Name of service:*
Street address:
Suburb:
State or Territory:*
Postcode:*
Complaint resolution
Would you like to be involved in the resolution process?
Yes No
What outcome would you like from this complaint?
Would you like feedback on the resolution of this complaint?
Yes No
You are about to submit this complaint form to the Aged Care Complaints Scheme. If the matter you are raising involves a serious issue affecting the safety, health or wellbeing of a care recipient, or if it relates to the commission of a serious offence, the Department of Health and Ageing may be obliged to refer relevant material to the appropriate external agency, including appropriate health professional regulatory bodies and the police.


Complainant information
Lodge complaint as:
Anonymous Complaint
This complaint relates to: *
The care or services I am receiving
The care or services someone else is receiving
Details of care recipient If this complaint relates to the care and services a specific resident is receiving, you may add their details here.


First Name:
Last Name:
Details of your complaint
What does your complaint relate to:*
[?]


Provide specific details about your concern here: *


 [?]
Details of aged care service
Which type of aged care service does the complaint or information relate to:*
[?]
Name of service:*
Street address:
Suburb:
State or Territory:*
Postcode:*
You are about to submit this complaint form to the Aged Care Complaints Scheme. If the matter you are raising involves a serious issue affecting the safety, health or wellbeing of a care recipient, or if it relates to the commission of a serious offence, the Department of Health and Ageing may be obliged to refer relevant material to the appropriate external agency, including appropriate health professional regulatory bodies and the police.


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