feedback form - 360.org.au … · we value your feedback there are several ways you can return this...
TRANSCRIPT
We value your feedback
Feedback Form
360HealthCommunitywww.360.org.au 360HealthCommunitywww.360.org.au
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What do we do well?
We value your feedback
There are several ways you can return this form:
• In person to a 360 team member
• Email to [email protected]
• Post to P.O. Box 354, Guildford WA 6935
Please return this form
Contact us for further information
P: 08 9376 9200E: [email protected]: www.360.org.au
Get in touch with us
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What could we do better?
Compliment
Date today: ________________
Date/s related to feedback: _________________
Time: ________________
Area or Service: ________________________
Location/s: ____________________________
If applicable, please complete the following.
Client name:_____________________________
Client date of birth: _______________________
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We would really like to hear about your experience. Please provide as much detail as possible, including who was involved.
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______________________________________________Information Privacy: Your feedback is treated with confidentiality and is not stored in client files. We will only collect, store, use and disclose your ‘personal information’ (including contact details), in accordance with the Privacy Act 1988 and our Privacy Policy.
Your Feedback
Type of feedback
Suggestion
Comment
Complaint
Name: ____________________________________
Address:___________________________________
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Email: _____________________________________
Phone: _______________________
Your details
I wish to remain anonymous
I am happy to be contacted regarding my feedback
Continued...
360HealthCommunitywww.360.org.au