Submit an online complaint

Instructions

The online complaint form must be completed and submitted at one time. This form cannot be saved before it is completed. When you submit this form a copy will be emailed to the nominated email address for your reference.

Alternatively you can lodge your complaint via email, fax or mail .

If you have difficulties completing or submitting this form please contact the Commission on 1800 043 159 from 9am to 5pm (Sydney time) weekdays.

If you are using a computer that is accessible to other people we recommend that you use the private browsing features of your browser when completing this form to preserve your privacy. Click here to find out more.

Before lodging a complaint

The Commission is required to give the health service provider/s you complain about your name and the nature of the complaint, although in special circumstances the Commission may withhold notification.  Unless there are good reasons not to, the Commission provides notice by giving a copy of your complaint to whoever the complaint is about and asks them to respond.

I have concerns about my name and complaint being released to the provider/s
My Details
Are you of Aboriginal or Torres Strait Islander descent?
I am the person who received the health service I am complaining about*required
Patient Details

You are lodging a complaint on behalf of another person who received the health service. Please complete their details below.

This person gave me consent to submit this complaint
The person is deceased
Is the Patient an Aboriginal or Torres Straight Islander?
Complaint Details

Please provide details of your complaint, including who provided the health service.

The main issues I am concerned about are:
Please select most important issues in your complaint below.

If you like to submit more details about your complaint and the issues of concern, you can upload more information below.

Note: If you have more attachments to include, please email them to Online_Complaint@hccc.nsw.gov.au after submitting this form.
Have you approached the health service provider about this complaint?
I have complained to another organisation about the same matter
Consent and Authorisation

It would assist the Commission to have your consent to access your medical records for the purpose of assessing this complaint.

It would assist the Commission to have the consent of the person who received the health service so that the Commission could request a copy of their medical records if required during the assessment process.
If you are the legal guardian or carer for a person, please provide your consent for the Commission to access the medical records of the person who received the service. If you complain on behalf of another person but you are not their carer or their guardian please indicate whether they have consented for you to lodge this complaint.

Authorisation
Survey
Mandatory field(s) marked with *

If you have difficulties completing or submitting this form please contact the Commission on 1800 043 159 from 9am to 5pm (Sydney time) weekdays.